Benefit Resources

With over 22,900 member locations throughout the United States, Vision Service Plan (VSP) is the largest provider of vision care in the nation. VSP contracts with independent optometrists and ophthalmologists in private practice to dispense materials as well, allowing patients to obtain all necessary services in one location.

FAQs - Frequently Asked Questions :

Who is the "covered member ?
The covered member, also referred to as the VSP member, is the person whose group or employer provides your VSP coverage. Also known as the primary subscriber or insured employee.

What is my Member I.D. number ?
The number assigned to you by your group or employer. The member I.D. is usually the covered member's Social Security number.

Social Security Numbers are routinely used for patient identification in health care. At VSP, we understand the privacy concerns surrounding one's Social Security Number. Rest assured your Social Security Number will only be used to administer your eye care plan. VSP does not release Social Security Numbers to unauthorized individuals.

Does your doctor network include Optometrists, as well as Ophthalmologists ?
Yes. VSP's doctor list includes highly skilled and professionally certified optometrists and ophthalmologists.

What's the difference between an Optometrist and an Ophthalmologist ?
An Optometrist is a doctor of optometry (O.D.) who is a health care professional trained and state licensed to provide primary eye care services. These services include comprehensive eye health and vision examinations; diagnosis and treatment of eye diseases and vision disorders; the detection of general health problems; the prescribing of glasses, contact lenses, low vision rehabilitation, vision therapy and medications. Optometrists may also perform certain surgical procedures and the counseling of patients regarding their surgical alternatives and vision needs related to their occupations, avocations and lifestyle.

In addition to performing the functions of an optometrist, an Ophthalmologist is a doctor of medicine (M.D.) who specializes in medical and surgical management of disorders and diseases of the eye. Ophthalmologists may treat and manage eye conditions through the application of surgical procedures and medical prescriptions.

How can I find a VSP doctor ?
Finding a VSP doctor is easy. VSP provides two convenient methods of finding a VSP doctor. You can either visit the VSP Doctor Directory online or you can contact Member Services.

Once I find a VSP doctor, or if I decide to change my VSP doctor, how do I notify you of my selection ?
You do not need to notify VSP of your selection or change in VSP doctors. When you're ready, simply make an appointment with a VSP doctor.

Can I see an out-of-network provider ?
Only if your group's VSP coverage allows services from an out-of-network provider. VSP will reimburse you up to the amount allowed under your plan's out-of-network provider reimbursement schedule. The reimbursement rate does not guarantee full payment, and VSP cannot guarantee patient satisfaction when services are received from an out-of-network provider.

How do I submit an out-of-network claim for reimbursement ?
If you are eligible for services from an out-of-network provider, pay the entire bill at the time of services from the provider.
Then send the following information to VSP :

An itemized bill listing the services you received
The name, address and phone number of the out-of-network provider
The covered member's Social Security number or VSP member identification number
The covered member's name, phone number and address
The name of the group that provides your VSP coverage
The patient's name, date of birth, phone number and address
The patient's relationship to the covered VSP member (such as "self," "spouse," "child," "student," etc.
You have six months to submit a claim.

Please keep a copy of the information for your records and send the originals to the following address :

Vision Service Plan
Attn: Out-of-Network Provider Claims
P.O. Box 997100
Sacramento, CA 95899-7100

Do I need an I.D. card ?
With VSP, you don't need an I.D. card to visit a VSP doctor. Simply call a VSP doctor to schedule an appointment. Be sure to tell the doctor you are a VSP member when making your appointment. The doctor and VSP handle the rest!

Do I need to fill out a claim form prior to receiving eye care services ?
VSP members do not complete any paperwork, including claim forms. VSP doctors contact VSP to verify your eligibility, plan coverage and to obtain authorization for services. Upon completion of the appointment, the VSP doctor submits the claim to VSP for processing, and VSP pays the doctor directly.

Can I get an individual policy if I don't get vision insurance through my employer ?
At this time, VSP does not offer individual plan coverage. If you're not a VSP member, be sure to ask your employer or group to look into offering VSP coverage.

How do I verify my eligibility and plan coverage ?
Click on Verify Your Coverage. This section of the Web site allows you to view your eligibility and coverage information. To use the program, you need to input the covered member's I.D. number and last name.

Am I responsible for a copayment when I visit my VSP doctor ?
Yes, if your group's VSP plan includes a copayment, you will need to pay that to the VSP doctor during your visit. Copayments typically apply to both you and your dependents covered under your VSP plan. Click on Verify Your Coverage for copayment information.

What are some frame and lens options that may require out-of-pocket expenses on my part ?
Examples include :

Scratch-resistant coating
Anti-reflective coating
Ultraviolet (UV) protection
Progressive lenses
Blended bifocal lenses
Most tinted and photochromic lenses
Any frame valued at more than your plan's allowance

Am I limited to the kind of frame I can pick ?
Unlike other plans that may limit choice to a particular line of frames, your VSP frame benefit offers you the freedom to choose a frame that complements your lifestyle. If you choose a frame exceeding your plan allowance, you'll be responsible for paying this amount in addition to any applicable copayments at the time of your visit.

Can I choose contact lenses instead of eyeglasses ?
Yes, if your group's VSP plan has coverage for elective contact lenses. Keep in mind, if you choose contacts you may not be eligible to receive lenses and a frame during the same service period.

To find out if your plan allows this, click on Verify Your Coverage or contact Member Services.

I wear contact lenses. What's the difference between contact lenses that are "medically necessary" vs. "elective or cosmetic" ?
Many patients like the convenience of contact lenses, and elect to wear contacts instead of glasses as a personal choice, but they are not required to do so because of a medical condition that prevents them from wearing glasses. Medically necessary contacts are prescribed by your doctor as required for certain medical conditions and must be approved by VSP.

Why is the contact lens exam not covered as part of my routine eye exam ?
The contact lens exam is a special exam in addition to your routine eye exam and is important to ensure proper fit of your contact lenses and to evaluate your vision with the contact lenses. Depending on your needs, a doctor will provide value-added services, including training and education based on the type of services and materials provided. You should discuss the services that your doctor provides to better understand the value of their contact lens exam, as well as the extent of the services necessary for your individual eye health.

Why should I have my eyes examined regularly ?
Thorough eye exams are essential not just for detecting vision problems, but also as an important preventive measure for maintaining overall health and wellness. And your VSP WellVision coverage is designed to protect and enhance your eyesight - your most important sense. In fact, a thorough eye exam can detect certain medical eye conditions, such as glaucoma. Caring for your eyes should always be a part of your regular health care routine.

How frequently should I have my eyes examined ?
As a rule, you should not go beyond two years to have your eyes examined, and the recommended care is an exam every year. Those with a family history of eye diseases, diabetic patients, and anyone whose general health is poor or who are taking medications that may have potential side effects on the eye may need to have their eyes examined twice a year. You and your doctor should determine the eye exam schedule that best meets your eye care needs.

When should my child have his or her first eye exam ?
The American Optometric Association suggests that children should have their first regular eye exam at 6 months. Follow up exams should be done around age two to three because this is the age when a child's visual system undergoes its most rapid development and vision correction is most effective.

How frequently should children's eyes be examined after their initial exam ?
As with adults, children's eyes should be examined every two years - or more frequently if there is an eye or vision problem or a family history of eye disease. School children use their eyes more frequently than adults to read and perform other school activities, so it's extremely critical for them to have regular eye exams. Also, it is important to remember that an eye screening typically offered at school only tests distance. Screenings will not detect some vision problems. Your child can have problems with near vision, eye coordination and focusing and still have 20/20 distance vision. If left untreated, these problems can cause learning disabilities, headaches and other visual discomforts.

Do I need a special eye exam as I get close to, or past, age 40 ?
You don't need a special eye exam over age 40, but it's critical that you have your regular eye exam at least every two years. As we get older, we are more susceptible to certain eye diseases such as cataracts, glaucoma, and macular degeneration. Getting your eyes regularly examined enables your eye doctor to detect the first signs of disease and prescribe the appropriate treatments to prevent vision loss.

How can I find out more about Laser Vision Correction ?
VSP now offers many members the option of laser vision correction surgery to correct such visual acuity problems as near sightedness, farsightedness and even astigmatism. For more details, visit Laser VisionCare VSP's Laser VisionCare home page.

How do I get other questions answered ?
If you have additional questions about your VSP coverage, contact Member Services.