Below are answers to some frequently asked questions from VSP members. If you have a question that is not addressed here, please contact Member Services for additional assistance.
Does VSP's doctor network include optometrists as well as ophthalmologists?
How can I find a VSP network doctor?
Once I find a VSP network doctor, or if I decide to change my VSP network doctor, how do I notify VSP of my selection?
Can I see a provider that is not part of VSP's doctor network?
How do I submit an out-of-network claim for reimbursement?
Do I need an ID card?
Do I need to fill out a claim form before I receive eyecare services?
Can I purchase an individual plan if I don't receive vision insurance through my employer or health plan?
How do I verify my eligibility and plan coverage?
Why do I need to register?
Why do I need to log in to see my benefits?
Why is an e-mail address required?
How do I change my password or user ID?
Am I responsible for a copay when I visit my VSP network doctor?
What are some frame and lens options that may require out-of-pocket expenses?
Am I limited to the kind of frames I can choose?
Can I choose contact lenses instead of glasses?
Why is the contact lens exam not covered as part of my routine eye exam?
Why should I have my eyes examined regularly?
How often should I have my eyes examined?
What is the difference between a routine eye exam and a contact lens exam?
When should my child have his or her first eye exam?
How often should children's eyes be examined after their initial eye exam?
Do I need a special eye exam as I get close to, or past, age 40?
How can I find out more about laser vision correction?
My plan provides me with a discount on laser vision surgery; can I see an out-of-network provider?
Can I see an out-of-network provider if my benefits include an allowance and a discount for laser vision surgery?
Q. Who is the covered member?
A. 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 enrollee.
Q. What is my member ID number?
The number assigned to you by your employer or health plan that is not your Social Security Number.
Q. Does VSP's doctor network include optometrists as well as ophthalmologists?
A. Yes. VSP's network doctor list includes highly skilled and professionally certified optometrists and ophthalmologists.
Q. How can I find a VSP network doctor?
Q. Once I find a VSP network doctor, or if I decide to change my VSP network doctor, how do I notify VSP of my selection?
A. You don't need to notify VSP when you choose or change your VSP network doctor. When you're ready, simply make an appointment with a VSP network doctor.
Q. Can I see a provider that is not part of VSP's doctor network?
A. Only if your group's VSP coverage allows services from a non-VSP provider. VSP will reimburse you up to the amount allowed under your plan's out-of-network reimbursement schedule. You'll receive a lesser benefit and typically pay more out-of-pocket. The reimbursement rate does not guarantee full payment, and VSP cannot guarantee patient satisfaction when services are received from a non-VSP provider.
Q. How do I submit an out-of-network claim for reimbursement?
A. If your plan includes out-of-network coverage and you are eligible for services, you will be required to pay the provider in full at the time of service. To confirm your coverage, log in to vsp.com.
To ensure a timely reimbursement, log in to vsp.com and access our online Out-of-Network Reimbursement Form on the “My Benefits” page under “Benefit Resources,” or send the following information to VSP:
- An itemized receipt listing the services you received
- The name, address and phone number of the non-VSP provider
- The covered member's ID number
- The covered member's name, phone number and address
- The name of the organization that provides your VSP coverage
- The patient's name, date of birth, phone number and address
- The patient's relationship to the covered member (such as "self," "spouse," "child")
Please keep a copy of the information and mail the originals to the following address:
Attn: Out-of-Network Claims
P.O. Box 997105
Sacramento, CA 95899-7105
Most out-of-network claims must be submitted to VSP within six months for reimbursement. However, certain plans may allow out-of-network claims to be submitted beyond the six-month deadline. Please review your plan information for exact time frames.
Q. Do I need an ID card?
With VSP, you don't need an ID card to visit a VSP network doctor. Simply call a VSP network 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!
Q. Do I need to fill out a claim form before I receive eyecare services?
A. VSP members don't complete any paperwork, including claim forms. VSP network doctors contact VSP to verify your eligibility, plan coverage and to obtain authorization for services. Upon completion of the appointment, the VSP network doctor submits the claim to VSP for processing and VSP pays the doctor directly.
Q. Can I purchase an individual plan if I don't receive vision insurance through my employer or health plan?
Q. How do I verify my eligibility and plan coverage?
A. Register on vsp.com and you can:
View your coverage, including eligibility and copayment information Find a VSP doctor near you See details of previous VSP doctor visits and savings (when applicable) Get instructions on how to use your benefitTop
Q. Why do I need to register?
A. We ask that you register and create a user ID and password to
protect the privacy of your information. You choose your own user ID and password during the registration process. You
are the only person who knows your password, and you can change it at any time.
Q. Why do I need to log in to see my benefits?
A. To protect the privacy of your information, we ask that you log in to access the secure areas of our site.
Q. Why is an e-mail address required?
A. We ask for your e-mail address to send you administrative
emails confirming changes to your user ID and/or password. You will never receive e-mail from someone other than VSP
as a result of registering with us, and if you choose to receive informational e-mails, you will only receive e-mails
related to the topics you select.
Q. How do I change my password or user ID?
A. You can change them at any time through the “Your Profile” link on the registration page.
A. Yes, if your group's VSP plan includes a copay, you will need to pay it to the VSP network doctor during your visit. Copays typically apply to both you and your dependents covered under your VSP plan. Go to Benefits Information for copay information.
Q. What are some frame and lens options that may require out-of-pocket expenses?
A. 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 allowanceWhen you visit a VSP network doctor, you may receive extra savings on some frame and lens options. Please check your plan information for details.
Q. Am I limited to the kind of frames I can choose?
A. Unlike other plans that may limit your choice 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 copays at the time of your visit.
Q. Can I choose contact lenses instead of glasses?
A. Yes, if your group's VSP plan has coverage for contact lenses. Keep in mind, if you choose contacts, you may not be eligible to receive any frame and lenses during the same service period. To find out if your plan allows this, go to Benefits Information or contact Member Services.
Q. Why is the contact lens exam not covered as part of my routine eye exam?
A. The contact lens exam is a special exam in addition to your routine eye exam. This special contact lens exam ensures the proper fit of your contacts and evaluates your vision with the contacts. Depending on your needs, a doctor will provide training and education based on the type of services and eyewear 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.
Q. Why should I have my eyes examined regularly?
A. 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 coverage is designed to protect and enhance your eyesight — your most important sense. In fact, a thorough eye exam can detect a number of serious medical conditions, such as glaucoma, cataracts and diabetes. Even cancer. Caring for your eyes should always be a part of your regular healthcare routine.
Q. How often should I have my eyes examined?
A. You and your doctor should determine the eye exam schedule that best meets your eyecare needs. However, as a rule, you should not go beyond two years to have your eyes examined, and the recommended care is an eye 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 more often.
Q. What is the difference between a routine eye exam and a contact lens exam?
A. Routine eye exams are designed to detect vision problems and are an important preventive measure for maintaining your overall health and wellness. In fact, a thorough eye exam can detect a number of serious medical conditions, such as glaucoma, cataracts, diabetes and even cancer.
Contact lens exams are designed to evaluate your vision with contacts. Although your vision may be clear and you feel no discomfort from your lenses, there are potential risk factors with improper wearing or fitting of contact lenses that can affect the overall health of your eyes.
Q. When should my child have his or her first eye exam?
A. The American Optometric Association suggests that children should have their first regular eye exam at six months of age. Follow up exams should be done around age two to three because a child's visual system undergoes its most rapid development at this age and vision correction is most effective.
Q. How often should children's eyes be examined after their initial eye exam?
A. As with adults, children's eyes should be examined every two years — or more often — if there is an eye or vision problem or a family history of eye disease. School children use their eyes more often than adults to read and perform other activities, so it's critical for them to have regular eye exams. Also, it's 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.
Q. Do I need a special eye exam as I get close to, or past, age 40?
A. 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. A regular eye exam enables your eye doctor to detect the first signs of disease and prescribe the appropriate treatments to prevent vision loss.
Q. How can I find out more about laser vision correction?
A. VSP now offers many members the option of laser vision correction surgery to correct vision problems such as nearsightedness, farsightedness and even astigmatism. For more details, go to Laser VisionCare.
Q. My plan provides me with a discount on laser vision surgery; can I see an out-of-network provider?
A. You have the Laser VisionCare Program. Discounts are only available from VSP contracted laser centers. For more information, login to VSP’s Member Resource Center and go to View Your Benefits, or contact your human resources representative. To find a VSP contracted laser center, visit the VSP Member Resource Center at vsp.com.
Q. Can I see an out-of-network provider if my benefits include an allowance and a discount for laser vision surgery?
A. You have the Laser VisionCare Preferred Program. To find out if your plan allows you to visit an out-of-network provider, login to VSP’s Member Resource Center and go to View Your Benefits, or contact your human resources representative.
Q. How do I get other questions answered?