What's Covered
When you use a VSP network doctor, all eligible services are covered at no cost to you after you meet the $15 copayment.
When you use a non-VSP provider, VSP will reimburse you up to the plan limits. If the actual cost is higher, you are responsible for costs above the plan limits. Services obtained from a Non-VSP provider are in lieu of obtaining services from a VSP doctor and count toward plan benefit frequencies.
The following standard vision services are covered:
- Eye Examination: A complete initial vision analysis which includes an appropriate examination of visual functions, including the prescription of corrective eyewear where indicated.
- Lenses: The vision provider will order the proper lenses necessary for your visual welfare and verify the accuracy of the finished lenses.
- Frames: The vision provider will assist in the selection of frames, properly fit and adjust the frames, and provide subsequent adjustments to frames to maintain comfort and efficiency.
- Contact lenses: Contact lenses are available in lieu of all other lens and frame benefits. Necessary contacts are available when specific benefit criteria are satisfied and when prescribed by your doctor. When you obtain necessary contact lenses from a VSP doctor, professional fees and materials will be covered. When Elective contact lenses are obtained from a VSP doctor, VSP will provide an allowance toward the cost of professional fees and materials. A 15% discount shall also be applied to the VSP doctor’s usual and customary professional fees for contact lens evaluation and fitting. Contact lens materials are provided at the VSP doctor’s usual and customary charges.
Low Vision Services and Materials
The Low Vision Benefit provides special aid for people who have acuity or visual field loss that cannot be corrected with regular lenses. If a covered person falls within this category, he or she will be entitled to professional services as well as ophthalmic materials, including but not limited to, supplemental testing, evaluations, visual training, low vision prescription services, plus optical and non-optical aids.
Services may be performed by an affiliate provider who has agreed to bill VSP directly. Benefits include:
- Supplemental testing: Up to $125. Includes evaluation, diagnosis, and prescription of vision aids where indicated.
- Supplemental aids: 75% of the affiliate provider's fee up to $1,000.
- Maximum low vision benefit: $1,000 every two years and a maximum of two supplemental tests within a two-year period.
Exclusions and limitations for low vision benefits
- Exclusions and limitations of benefits described above for VSP doctors also apply to services rendered by affiliate providers.
- Services from an affiliate providers are in lieu of services from a VSP doctor or a non-VSP provider.
- VSP is unable to require affiliate providers to adhere to VSP’s quality standards.
- Where affiliate providers are located in membership retail environments, you may be required to purchase a membership in such entities as a condition of obtaining plan benefits.
Primary eyecare plan is designed for the detection, treatment and management of eye conditions and other conditions that produce eye or visual symptoms. Under the plan, VSP doctors provide treatment and management of urgent and follow-up services. The plan also involves management of conditions that require monitoring to prevent future vision loss. The primary eyecare copayment is $20 per visit.
The VSP doctor advises and educates you on matters of general health and prevention of eye disease. If consultation, treatment, or referral are necessary, the VSP doctor manages and coordinates on your behalf to assure appropriateness of follow-up services.
Symptoms
Examples of symptoms for which you might seek services under the specialty eyecare services plan include, but are not limited to:
- Eye discomfort or pain
- Transient loss of vision
- Flashes or floaters
- Eye trauma
- Diplopia
- Recent onset of eye muscle dysfunction
- Something in your eye
- Swollen eyelids
- Red eyes
Conditions
Examples of conditions which may require management under the specialty eyecare services plan include, but are not limited to:
- Ocular hypertension
- Retinal nevus
- Glaucoma
- Cataract
- Pink-eye
- Macular degeneration
- Corneal dystrophy
- Corneal abrasion
- Blepharitis
- Sty
Exclusions And Limitations
Specialty eyecare services do not cover the following:
- Costs associated with securing materials such as lenses and frames
- Orthoptics or vision training and any associated supplemental testing
- Surgical or pathological treatment
- Any eye examination, or any corrective eyewear required by an employer as a condition of employment
- Medication
- Pre- and post-operative services
- Services and/or materials not indicated elsewhere in this online benefits handbook