Declination of Vision Insurance
Dependent vision coverage is
available only if the dependents are also covered by the State
medical plan. You may decline vision coverage for your family. To
decline vision coverage for your family, employees must complete a
Dependent Vision Declination form. The effective date is the first
of the month following the declination. After declining, you may
only add your family to vision coverage when there is an open
enrollment for vision. There may be several years between open
enrollment periods for vision.
Participating Providers
You can use any provider you want,
but you may save money when you use providers who belong to the
State plan network. Most benefits are paid based on Allowable
Charges, which means they’ll accept plan benefits plus your
share (any deductible, coinsurance or co-payments) of the costs as
payment in full.
Non-participating Providers may
charge more than the plan’s Allowable Charges, which means you are
responsible for any amounts that exceed the Allowable charges plus
any deductible and coinsurance amounts. An exception may be made
when you have to use a non-participating provider for an emergency
or because a non-participating provider is the only source of
services.
To find Participating Vision
Providers, please contact Vision Service Plan, 1-800-877-7195 or go
on-line
http://www.vsp.com Go to
"Members & Consumers", then select "Find a VSP Network Doctor".
When logging onto their website
for the first time you'll need to register by clicking on the light
purple box labeled "Members & Consumers". Then in the login box use
the "Register now" link to create your username and password. First
you will be asked for your Social or Member ID number. DO NOT use
your Social instead put in your full Member/Enrollee ID Number
(Minus the 3 letter Prefix), full name and birthday then click
continue. On the next screen you'll be asked to enter a username,
password, security question, etc. for your account. After filling
out the rest of your personal information your registration will be
complete. If you encounter any problems or need customer service
call VSP at the number listed above.
Filing Claims
Participating providers will
bill the plan on your behalf. When you use a non-participating
provider, you will have to make a claim for reimbursement. Submit a
detailed invoice from your provider. Be sure to include your name,
subscriber identification number
(Your VSP subscriber
identification number is your Blue Cross Identification number less
the 3-letter prefix.) and the name of
your employer to the following address:
VSP
PO Box 997105
Sacramento, CA 95899-7105
For faster reimbursement from
VSP, complete their on-line reimbursement form,
http://www.vsp.com/
and submit it to the above address with the appropriate invoice.
You can also complete the
Out-of-Network Reimbursement Form and fax it to VSP at
916-851-5152.
Summary of
VSP Plan
|
Plan Features |
Vision Care Benefits (VSP)
|
| Professional Fees |
VSP pays up to
the amounts listed:
|
Materials - Lenses
Per Pair
|
- Single Vision, up to $32
- Bifocal, up to $60
- Trifocal, up to $72
- Lenticular, up to $100
- Frame, up to $30
|
Contact Lenses - Per
Pair
(evaluation, materials, and fittings only)
|
- Effective, up to $47
- Medically Necessary, up to
$100
|
Service Frequency
Limitations
|
- Insured may receive 1 eye
exam every 12 months.
- Insured may receive 1 pair
spectacle lenses or contact lenses every 12 months.
- Insured may receive 1 frame
every 24 months.
|
