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.
after $10 copayment
|Lenses (including tints)
:: Single Vision Lenses
:: Bifocal Lenses
:: Trifocal Lenses
:: Lenticular Lenses
after $25 copayment*
after $25 copayment
both lenses and frames are purchased , only one $25
** Within plan limitations. If selected frame costs
more than plan allowance, there will be an additional
(in place of exam, lenses and frames)
after $25 copayment
This chart is only a summary. Please
see the evidence of coverage or disclosure form for the
selected plan for a thorough description of its benefits,
limitations, exclusions and conditions of coverage.
||FAQs - Frequently Asked Questions :
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.
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.
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.
doctor network include Optometrists, as well as Ophthalmologists
Yes. VSP's doctor
list includes highly skilled and professionally certified
optometrists and ophthalmologists.
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.
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
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
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.
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 :
bill listing the services you received
address and phone number of the out-of-network provider
member's Social Security number or VSP member identification
member's name, phone number and address
of the group that provides your VSP coverage
name, date of birth, phone number and address
relationship to the covered VSP member (such as "self,"
"spouse," "child," "student,"
six months to submit a claim.
Please keep a copy of the information for your records
and send the originals to the following address :
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.
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.
some frame and lens options that may require out-of-pocket
expenses on my part ?
and photochromic lenses
valued at more than your plan's allowance
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.
find out if your plan allows this, click on Verify
Your Coverage or contact Member
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.
the contact lens exam not covered as part of my routine eye
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.
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.
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
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.
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
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.
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
VisionCare home page.
I get other questions answered ?
If you have additional
questions about your VSP coverage, contact Member