When you receive an examination, spectacle lenses and/or frames from a member doctor, the doctor accepts the payment as payment in full (provided you stay within the limitations of the program), except for your VSP copayment of $10 payable at the time of the examination, and an additional copayment of $15 toward the cost of lenses and/or frames. Only the exam copayment applies toward contact lenses.
When you receive services from a non-member doctor, you will be reimbursed directly according to the Non-Member Reimbursement Schedule.
For information regarding the vision networks for exempt employees, see the Vision Service Plan chart below.
Click chart to enlarge.
Routine vision benefits include:
- An annual eye exam
- Glasses or contact lenses
- Lenses - Once every 12 months
- Frames - Once every 12 months
- Frames are covered up to $120 and lens options include standard polycarbonate and standard progressive (no-line) bifocals at no additional cost.
- Contact Lenses - In place of spectacle lenses and frames VSP offers discounts on laser vision surgery, but does not provide surgical benefits.
The vision benefits provided through VSP include:
Vision Examination - A complete analysis of the eyes and related structures to determine the presence of vision problems. Contact lens evaluation and fitting and additional supplemental tests are not covered under the vision examination.
Lenses - The member doctor will order the proper lenses. The doctor also will verify the accuracy of the finished lenses. Note: Progressive lenses (no-line bifocal and trifocal lenses) are a covered benefit.
Frames - Frames within the plan allowance are covered in full. If you select a frame that costs more than the wholesale allowance (or a large frame that requires oversized lenses) there will be an additional charge. More expensive frames are available at a controlled cost, by agreement between the member doctor and VSP. To minimize your out-of-pocket expenses, ask your provider to show you frames priced within the benefit allowance.
Necessary Contact Lenses - If you use an out-of-network doctor, the necessary contact lens benefit maximum is $210. Contact lenses and the necessary opthalmic materials are covered in full, less the applicable $15 copayment, when a member doctor receives prior approval to:
- Correct problems not correctable with spectacle lenses;
- Correct significant anisometropia;
- Treat keratoconus; or
- Provide treatment following cataract surgery.
Elective (Cosmetic) Contact Lenses - When contact lenses are chosen for reasons other than those above, they are considered elective. An allowance of $125 with no copayment will be made toward their cost in place of spectacle lenses and frames for the benefit period.
Laser VisionCare Program - Through VSP's Laser VisionCare Program, patients may obtain a 20 to 25 percent discount on PRK and LASIK surgery up to a maximum charge of $1,500 and $1,800, respectively, per eye. Details about VSP's Laser VisionCare Program, as well as comprehensive information about laser vision correction surgery, can be found in the WellVision Learning Source area of VSP's web site or by contacting VSP at 800-877-7195 or TDD for the hearing impaired at 800-428-4833.
Patients may obtain additional pairs of prescription glasses at a 20 percent discount off usual and customary charges. In addition there is a 15 percent discount off contact lens professional services (materials provided at usual and customary fees). These discounts are available for 12 months following the patient's last covered eye examination from the member doctor who provided that examination.
To receive vision care benefits, follow the procedure for one of the three options below.
Option 1: Choose A Member Doctor/Provider
Step 1 - Choose a doctor from the list of member doctors and make an appointment for an examination and tell him/her that you have VSP coverage.
Step 2 - The doctor will take care of all paperwork for payment. VSP will pay the doctor for the services you received according to their agreement with that doctor.
Option 2: Choose A Non-Member Provider
Step 1 - Make an appointment and receive the necessary services from the provider. Pay the provider his/her full fee and obtain an itemized bill which must contain:
1. The patient’s name;
2. The date services began;
3. The service and materials received;
4. The type of lenses received (single, bifocal, trifocal, etc.); and
5. The subscriber’s name, address and Social Security number.
Step 2 - Mail the itemized bill to your provider. Claims must be filed within six months from the date of service.
Vision Service Plan
P.O. Box 997100
Sacramento, CA 95899-7100
Option 3: See A Non-Member Provider and Have A Member Doctor Fill Your Prescription
Step 1 - After receiving an examination from the provider, pay the provider his/her exam fee. Obtain an itemized bill for the exam and the prescription for your lenses/contacts. Send the exam bill to VSP. You will be paid directly according to the Non-Member Provider Reimbursement Schedule for your exam. (See the Member Benefits and Non-Member Reimbursement Schedule for more information.)
Step 2 - Contact the member doctor to see if he/she will fill a prescription from another doctor.
Step 3 - Take your prescription to the member doctor on your first visit.
Step 4 - The member doctor will fit you with your new glasses/contacts and take care of any paperwork for payment. The doctor will be paid by VSP or EyeMed Vision Care for dispensing your glasses/contacts according to their agreement with the doctor. You are responsible for any applicable copayments.
The vision benefit is designed to cover your vision needs rather than elective materials. There will be extra costs involved if you select materials or services which are elective in nature, such as:
- Oversized frames;
- A frame that costs more than the plan allowance;
- Elective contact lenses costing more than $125;
- Tinted or coated lenses;
- Supplemental tests in addition to the standard vision exam;
- Sunglasses; or
- Materials or services not necessary for visual welfare.
Items not covered include:
- Orthoptics, vision training or non-prescription lenses;
- Lenses and frames under this program which are lost, stolen or broken. These will not be replaced unless you are eligible for frames or lenses at that time;
- Two pairs of glasses in place of bifocals;
- Medical or surgical treatment of the eyes;
- Services or materials as a result of any Workers’ Compensation law or similar legislation;
- Any eye exam required by an employer as a condition of employment; or
- Any services or materials provided by any other vision care plan or group benefit plan containing benefits for vision care.
If you are not legally blind, but your eyesight cannot be corrected to 20/70 with the use of optical lenses, you may be eligible to receive low vision benefits. Here is how the low vision benefit works:
- If your participating doctor finds that you have a low vision condition, the provider requests authorization from VSP to do more tests, gather information and propose a treatment plan for you.
- If VSP approves you for low vision benefits, you may be covered for additional prescription services and vision aids.
- You will have to pay 25 percent of the low vision benefits; VSP will pay the remaining 75 percent. Low vision benefits are only available to a maximum of $1,000 (excluding the copayment) for every two years.
- If you think you or a family member might have a need for these services, talk with your participating doctor about low vision benefits.
For questions about vision benefits, claims or participating VSP vision providers:
Call Vision Service Plan at 800-877-7195.
Group Number: 12022518
Visit the Vision Service Plan website at: vsp.com.