Under the VSP Choice Plan^®, your patient’s frame allowance is represented by a combination of the wholesale frame amount and corresponding retail amount for which your patient is covered. Although patients will only be informed of their retail allowance, they’re covered for any in-network (or covered) frame less than or equal to their wholesale or retail allowance. You receive your frame dispensing and the wholesale cost up to their wholesale allowance, plus collect any overage according to our frame overage procedures.

Most patients with a VSP Choice Plan will have a minimum extra $20 on top of their frame allowance when they select Marchon^® or Altair^® frames. Look for the wholesale and retail allowances for Marchon/Altair and all other frames indicated on the Patient Record Report at authorization. You’ll be reimbursed based on the wholesale equivalent of the patient's retail allowance for Marchon and Altair frames.

Your patient can apply the frame allowance to any frame, listed or unlisted, (except for out-of-network frames in which case the patient's out-of-network frame allowance should be applied). If patients choose unlisted frames, use your acquisition cost instead of the Frames catalog price when submitting the “wholesale cost” to VSP.

There is no charge to patients for standard frame cases; however, you may charge patients for special orders or for deluxe frame cases.

VSP does not provide a dispensing fee when a patient-supplied frame is used and patients can't be charged any additional fees.

Patients are also eligible for savings on additional services and materials (see Value-Added Benefits below).

Charge the patient according to our frame overage procedures. When the selected frame exceeds both the wholesale and equivalent retail allowance coverage, your patient is responsible for the overages exceeding his or her retail frame allowance at 80% of U&C. Don’t charge your patient more than 80% of U&C on frame overage, plus any applicable sales tax.

For more information, refer to the Providing Frames section in the VSP Manual.

• Single vision, bifocal, trifocal, or lenticular lenses in plastic or glass
• Eye sizes up to and including 60mm
• Polycarbonate lenses for monocular patients, dependent children, and handicapped patients
• Lined multifocal lenses in all segment widths, including occupational lenses. See the Dispensing & Patient Lens Enhancements section of the VSP Manual for specific details on occupational lenses
• Prism and slab off
• Base curves (regardless of curve)

If your patient selects a lens enhancement that has a copay, collect the lens enhancement copay directly from the patient. You’ll be charged the VSP Choice Plan charge-back fee for those lens enhancements.

Covered with Additional Copay: For lens enhancements that are covered with copay, charge the patient the patient copay listed on the VSP Choice Plan Lens Enhancements Chart or 80% of your U&C fees, whichever is lower, or the client-specific copay indicated on the Patient Lens Enhancement Report.

If your patient chooses a covered lens enhancement, you’ll receive the Choice Plan covered service fee. We won’t apply a charge back.

To offer more customized coverage to clients and members, we’ve developed flexible lens enhancement programs that allow partial coverage for the most popular VSP lens enhancements, including anti-reflective (AR) coatings, photochromics, and progressives. Always refer to the online Patient Record Report and Lens Enhancements Charges report for complete information on lens enhancement coverage. The VSP Flexible Lens Enhancement Coverage Tip Sheet provides more information and helps you calculate patients' out-of-pocket expenses.

Elective Contact Lenses

Many clients provide coverage for contact lenses in lieu of prescription glasses. To qualify, patients must first be eligible for glasses. Refer to the Patient Record Report for the patient's specific type of coverage and contact lens allowances.

VSP patients may have the following elective contact lens benefits:

Contact Lens Exam Copay with Materials Allowance – Your patient has a copay toward contact lens exam services and a separate allowance for contact lens materials. The patient pays the contact lens exam services (initial fitting and evaluation, or F&E) copay or 85% of your U&C fees, whichever is less. VSP will reimburse the difference between the patient’s copay and 85% of your U&C fees. There is no copay for contact lens materials.

Exam And (Combined Contact Lens Allowance) – Your patient has a combined allowance toward contact lens exam services, calculated at 85% of your U&C fees, and materials. There is no copay for contact lens materials. Your patient is responsible for the difference between your fees for contact lens exam services (85% U&C) materials, and their contact lens allowance.

Covered Contact Lenses – Your patient is covered after a copay for contact lens exam services and an annual supply of contact lenses.

We’ll cover contacts in full for patients meeting the established necessary contact lens benefit criteria if those patients are eligible for materials on the date of service. Coverage is limited and may require special handling to ensure proper reimbursement. Refer to Visually Necessary Contact Lenses section in the VSP Manual for more information.

Don’t balance bill your patient. Apply exam and material (spectacle lenses and frame) copays for necessary contact lenses, unless otherwise specified.

Visually necessary contact lenses aren’t typically covered for patients who’ve received any elective cosmetic surgery, such as LASIK, PRK, or RK.

Note: For Visually Necessary Contact Lenses and Covered Contact Lenses, VSP will only cover an annual supply of materials based on the manufacturer’s replacement schedule. No additional contact lens materials may be billed to VSP through additional VSP plans/coverage’s the patient may have.

This rule also applies to Elective Contact Lens patients when the allowance exceeds an annual supply of contact lens materials based on the manufacture’s replacement schedule.

You may only coordinate benefits up to the annual supply of contact lens materials if plans permit. See Coordination of Benefits Between Multiple VSP^® Plans in the VSP Manual.

Many clients provide this coverage. Refer to the Low Vision section in the VSP Manual for more information.

The benefits below are considered a private transaction between you and your patient. Your patient is fully responsible for payment.

Charge 80% of U&C on additional eye exams.

Charge 80% of U&C for additional materials when complete pairs of prescription glasses and non-prescription sunglasses and blue light filtering glasses are dispensed within 12 months of the exam. The benefit:

• Is based on your total U&C fee.
• Is unlimited for 12 months on or following the date of the last covered eye exam.
• Is available through any VSP doctor. Use professional judgment when evaluating prescriptions from another provider. You may request an additional exam at 80% of U&C fee.
• Applies to prescription and non-prescription lenses.
• Doesn’t apply to cleaning products or repairs of prescription lenses or frames.

Charge 85% of U&C on contact lens services. This benefit:

• Is subtracted from your U&C fee for evaluation, fitting, and follow-up services for prescription contact lenses.
• Is unlimited for 12 months on or following the date of the covered eye exam.
• Is available through any VSP doctor. Use professional judgment when evaluating prescriptions from another provider. You may request an additional exam at 80% of U&C.
• Doesn’t apply to lenses, solutions, cleaning products, and service agreements.

Patients are eligible for routine retinal screening as a value-added feature to complement their WellVision Exam^® benefit.

Please see the Retinal Screening section of the VSP Manual for more information.

• Members receive a complimentary screening as well as preoperative and postoperative services through participating VSP doctors.
• The program includes access to either Photorefractive Keratectomy (PRK) or Laser In-Situ Keratomileusis (LASIK) at a reduced cost, up to a maximum fee to the patient of $1,500 per eye for PRK, $1,800 per eye for LASIK, and $2,300 per eye for Custom PRK LASIK with wavefront technology using the microkeratome only or Bladeless LASIK.
• If the laser center is offering a temporary price reduction, VSP members will receive 5% off the advertised price if it is less than the usual discount price.
• Please see the Laser VisionCare program page on VSPOnline for information on how to participate or for a list of participating facilities.

• The Diabetic Eyecare Plus Program provides medical eye care services for members with diabetic eye disease, glaucoma, or age-related macular degeneration (AMD). Retinal screening is also available to eligible patients who have diabetes but don’t show signs of diabetic eye disease.
• Please see the Diabetic Eyecare Plus Program^SM section for more information.

The VSP Choice Plan may also be sold with the following supplemental plans:

Note: If your patient chooses a covered lens enhancement, there’s no charge. If your patient selects any other lens enhancements, charge the patient according to the VSP Choice Plan Lens Enhancements Chart or your U&C fees, whichever is lower. You may charge 80% of your U&C fees for lens enhancements not listed on the VSP Choice Plan Lens Enhancements Chart. You’ll be charged back the VSP Choice Plan lab fee for those lens enhancements.

See the VSP Computer VisionCare Plan section of the VSP Manual for more information.

Note: If your patient chooses a covered lens enhancement, there’s no charge. If your patient selects any other lens enhancements charge the patient according to the VSP Choice Plan Lens Enhancements Chart or your U&C fees, whichever is lower. You may charge 80% of your U&C fees for lens enhancements not listed on the VSP Choice Plan Lens Enhancements Chart. You’ll be charged back the VSP Choice Plan lab fee for those lens enhancements.

Doctors are paid Choice fees for the materials dispensing. See Lab instructions for materials dispensed under these supplemental plans.

Reminder: Obtain a separate authorization for these plans and follow the plan information provided on the authorization.

See Services Subject to Review/Audit for information regarding material record keeping requirements.