The ProTec Safety Plan provides a range of hazardous work environment coverage options for clients and members. With ProTec Safety, your patients can see you for their safety eyewear needs, which provide continuity of care for your patients.

Safety Requirements Questionnaire

ProTec Safety patients should complete a questionnaire about their work environments and related safety requirements before receiving safety services. You can use VSP’s Safety Requirements Questionnaire if you’d like or one you’ve created. Keep a copy of the completed questionnaire in your patients’ record.

Coordination of Benefits

There’s no coordination of benefits under the ProTec Safety plan.

ProTec Safety patients may have routine VSP coverage that covers their routine exam where work safety needs may additionally addressed, as appropriate. Please refer to the Patient Record Report for exam coverage and benefit information because your patients may have different coverage.

If a patient would like their safety prescription filled, it must be under two years old. Additional you can choose to require a new exam prior to providing materials based on your professional judgment. If you decide that an exam is necessary and the patient’s exam is not covered through their routine benefit or they do not have supplemental exam coverage under their ProTec Safety Plan, deduct 20% from the usual and customary (U&C) exam fee.

Necessary corrective lenses (i.e. single vision, bifocal, trifocal, or lenticular) in glass or plastic (CR-39) that meet the American National Standards Institute (ANSI) standards are detailed below for safety eyewear.

ANSI Requirements

The lenses and frames provided under this plan are certified as safe for the work environment by meeting the necessary requirements set forth by ANSI effective April 20, 2020.

Lenses

Covered Lens Enhancements

Covered lens enhancements are available and will vary depending on the patient’s benefit. VSP will pay the lab for any covered lens enhancement and there’s no charge to the patient. Refer to the Patient Record Report for lens enhancement coverage. In most cases, ProTec Safety patients will be covered for polycarbonate lenses.

Other Enhancements

If your patient selects a lens enhancement that is covered with copay,charge the patient your usual and customary fee (U&C) for the lens enhancement or their lens enhancement copay. (refer to the VSP Signature Plan Lens Enhancement Chart), whichever is lower. Refer to the Patient Record Report for lens enhancement coverage.

Non-covered Items

These options and items aren’t covered under the ProTec Safety plan and VSP will deny the claim if submitted for reimbursement:

• Contact lenses
• Everyday eyewear instead of safety materials
• Materials obtained from a non-VSP doctor, unless the group has out-of-network coverage
• Plano or non-prescription lenses, unless otherwise indicated on the Patient Record Report (minimum prescription ±0.50 diopters required for lenses)

Frames

Covered Frames

ProTec Safety patients can choose one of the 30 ANSI-approved frames from the ProTec Eyewear collection. Some member plans have a frame benefit that allows for choice of a ProTect Frame Retail Frame Allowance to use towards any Safety Rated frame outside of the ProTec Eyewear collection. These plans will have the detailed information on the Patient Record Record Report with the wholesale and retail allowances for the plan. ProTec Eyewear frames from the collection are fully-covered for the patient and will be supplied by a participating lab (see the Lab section for more details). Depending on the patient’s frame allowance, if the patient chooses a frame outside of the ProTec Eyewear collection, overages should be determined using the VSP Signature Plan frame overage policy. If the patient does not have a retail frame allowance as part of their benefit, the patient must select a frame from the ProTec Eyewear  collection or online catalog.

Non-Covered Frames

For patients that do not have a retail frame allowance and are required to select from the ProTec Eyewear collection and one of the following occurs:

• The needed eye size isn’t available in any of the covered frames
• None of the frames meets the hazardous work environment of your patient.
• The patient has an allergy to the standard safety frame materials used in the covered frames.

The non-ProTec Eyewear frame is not covered in full and you must submit a ProTec Safety Verification Form to document the exception. Once the exception is documented, then the patient will have a retail frame allowance of $65 (wholesale of $25). If the member chooses a frame with a cost that exceeds both the wholesale and retail allowances, deduct 20% from the retail overage. Determine the patient’s cost (if any) as you do today and collect any overages from the patient.

Additional Materials

When a complete pair of glasses, including plano sunglasses, is dispensed within 12 months from the date of the last eye exam, charge the patient 80% of U&C for non-covered materials. Refer to the Value-Added Benefits in the VSP Signature Plan^® section for details.

All ProTec Safety orders must be sent to a participating lab:

VSPOne Columbus
800.251.5150
2065 Rohr Road, Lockbourne, OH 43137

VSPOne Sacramento
800.952.5518
151 Blue Ravine Rd., Folsom, CA 95630

When billing electronically, eClaim will only offer these lab choices for ProTec Safety orders. If you don’t already have an account with the lab, you may submit the order, but they may contact you for more information.

Paper claim practices: You must order lab-supplied materials from the any of the participating labs listed above.

Emergency Situations

In emergencies, you can use any lab capable of producing ANSI certified safety eyewear (see the National Contract Lab List); choose lab 100 when billing on eClaim.

The following situations are considered emergencies. Include the reason for the emergency when submitting claims to VSP:

Use one of the following comments when indicating emergency status by selecting Lab Special Instructions:

• Patient’s safety glasses are lost, stolen, or broken and he or she doesn’t own a back-up pair.
• Patient needs safety glasses to work or drive, is unable to see well enough to do so, and doesn’t have a back-up pair of safety glasses.
• Patient’s safety and well-being will be jeopardized without the immediate delivery of his or her prescription safety eyewear.

Supplemental ProTec Safety Exams

The level of eye exam or the evaluation and management service that you provide depends on the location and the time elapsed since the patient’s last routine eye exam:

When possible, perform your supplemental and comprehensive or intermediate exams in the same visit.

*If you choose to use 920XX codes to bill your WellVision Exams, please remember to bill refraction (92015) separately for accurate reimbursement.

Stand-Alone ProTec Safety Plan Exams

Exams for Stand-Alone Safety EyeCare Plans are reimbursed at your Signature Plan comprehensive or intermediate exam payable fee.

Lenses

You’ll receive a flat rate dispensing fee of $25 for covered lenses. There are no additional reimbursements for dispensing progressive lenses or covered lens enhancements Use CPT code 99022 (for shipping) when submitting for progressive lenses to be reimbursed up to the maximum allowable.

Frame

When patients choose a covered ProTec Eyewear frame, it will be supplied by a participating lab. You won’t receive a dispensing fee or material reimbursement for the frame. When submitting the claim, be sure to look for the Collection with ProTec next to it (i.e. Baseline Collection – ProTec) when entering frame information on EasyFind, or use the UPC number listed on the online catalog to select the appropriate ProTect frame.

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