VSP’s material benefit is designed to provide corrective eyewear to members with visual needs. The minimum criteria for coverage is below. Unless your patient has plano coverage, plano or demo lenses may not be provided in a frame billed to VSP (exceptions apply; see LightCare Enhancement or Laser VisionCare: postoperative care). Providing frames with plano or demo lenses or providing demo lenses back to a patient for the purpose of placing them in a VSP covered frame is a violation of VSP’s policy.

If the patient does not have plano coverage as described above, the patient must pay for the non-covered frame as an out-of-pocket expense if the frame will contain plano lenses.

General guidelines when providing frames for VSP patients:

• Depending on lab policy, you can send the frame from your office to the lab, have the frame shipped directly from the manufacturer, or use a frame supplied by the lab.
• Unless your patient is eligible for plano lenses, only provide frames with prescription lenses in them that meet our minimum prescription criteria.
• Lenses that don’t meet our minimum prescription criteria aren’t covered by VSP and can’t be dispensed to your patient in or with a VSP-covered frame.

Frame companies listed on the Frame Companies/Lines List have completed our application and meet the following criteria:

• The manufacturer provides us and our doctors with current catalogs and wholesale price lists for their frames, or the manufacturer is listed in the Frames^® catalog.
• Catalog price or manufacturer’s wholesale price doesn’t exceed a 25% markup over the typical acquisition price.

When billing us for listed frame companies/lines, please use the frame price indicated on the manufacturer’s wholesale price list or the Frames catalog list as the wholesale cost. If the manufacturer is not listed on VSP’s Frame Companies/Lines List, use your acquisition price when indicating the wholesale cost for in-network frames.

Keep invoices of frame purchases other than those on the Frame Companies/Lines List for at least six years (ten years for Medicare managed care program providers) or as required by federal/state law, from the date of its creation or the date when it last was in effect whichever is greater. We may ask you for these invoices.

We include listed frame companies’ entire collections unless otherwise noted.

The purpose of the VSP Frame Companies/Lines List is solely to ease the administration of wholesale frame calculations and provider reimbursement rates. The list does not specify or guarantee that any particular frame manufacturer or frame brand will be covered by VSP at in-network rates. Certain manufacturers and/or brands may be designated by VSP as “out-of-network” and will be reimbursed on an out-of-network basis; this only applies to manufacturers or brands specifically designated as “out-of-network” frames.

No frame manufacturers or brands are currently on this list.

Under the VSP Signature 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.

Effective January 1, 2014, most patients with a VSP Signature Plan will have an 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.

Frame Overages

Charge your patient according to our frame overage procedures. When patients choose frames exceeding both their wholesale and equivalent retail allowances, they’re responsible for overages (any amount exceeding their retail frame allowance at 80% of your U&C). Don’t charge your patient more than 80% of U&C for frame overage, plus sales tax if it applies.

Don’t bill patients for standard costs to ship frames to you. Non-standard shipping costs are a private transaction between you and your patients. Tell patients what the cost will be before ordering frames.

Total charges to patients can’t exceed the retail price of frames.