Materials Coverage – VSP Essentials Plan
Materials coverage matches the VSP Advantage Plan except for lens enhancements, as outlined below.
Lenses
Covered Lens Enhancements
If your patient chooses a covered lens enhancement, you’ll receive the Advantage Network Lens Enhancements Chart covered service fee. We won’t apply the charge-back fee.
Other Lens Enhancements
If your patient selects any other lens enhancement, charge the patient 80% of your U&C fees and collect the lens enhancement cost directly from the patient. You’ll be charged back the Advantage Plan Network Lab Allocation fee for those lens enhancements.
Patient Charges
The following examples illustrate how to calculate “add-on” fees based on your total prices for a specific lens enhancement:
|
Your U&C fee for progressive is: |
$220 |
|
Subtract your U&C fee for bifocals (FT28): |
-$100 |
|
Your U&C add-on fee is: |
$120 |
|
Deduct 20%: |
-$24 |
|
Patient pays: |
$96 |
|
|
|
|
Single vision lens is covered in full. |
|
|
Your U&C fee for the AR coating is: |
$80 |
|
Deduct 20%: |
-$16 |
|
Patient pays: |
$64 |
Flexible Lens Enhancements
To offer more customized coverage to clients and members, we’ve developed several 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.
See Services Subject to Review/Audit for information regarding material record keeping requirements.