Repair/Replace Benefits

Repair/Replace Benefits cover materials your patients get when they’re not eligible for materials under their core plan. Refer to the Patient Record Report to determine if the patient is eligible for repair or replacement coverage. Patients are eligible if their spectacle lenses or frames are broken or damaged and need repair or replacement.

It also covers materials your patients receive when they’re not eligible for materials under the core plan and they can no longer use their glasses.

Patients covered under this additional benefit may be entitled to eyeglass lens and frame repair. Frame repair includes temples only, front only, hinge, and miscellaneous repairs. The Repair Benefit may also include replacement of a complete frame and/or basic lens.

Benefit Instructions

Patients need to bring the glasses to you before obtaining an authorization.
You’ll determine if glasses can be repaired. If they can’t, replacement may be covered.

Exam	Lenses	Frames
Exams aren’t covered.	New lenses are allowed if: repair or replacement for single vision or multifocal lenses will be approved if the doctor determines the glasses can’t be repaired; the benefit is limited to the patient’s core plan lens coverage. Note: Contact lens repair or replacement isn’t covered under this plan.	Replacement parts are covered if: frame temples, front, and/or hinges are damaged beyond repair; the benefit is limited to the patient’s core plan wholesale frame allowance. Replacement of the complete frame is covered if: frame is damaged beyond repair or the cost of repairing the parts exceeds the cost of replacement; the benefit will be limited to the patient’s core plan wholesale/retail frame allowance

Exam

Lenses

Frames

Exams aren’t covered.

New lenses are allowed if:

repair or replacement for single vision or multifocal lenses will be approved if the doctor determines the glasses can’t be repaired;
the benefit is limited to the patient’s core plan lens coverage.

Note: Contact lens repair or replacement isn’t covered under this plan.

Replacement parts are covered if:

frame temples, front, and/or hinges are damaged beyond repair;
the benefit is limited to the patient’s core plan wholesale frame allowance.

Replacement of the complete frame is covered if:

frame is damaged beyond repair or the cost of repairing the parts exceeds the cost of replacement;
the benefit will be limited to the patient’s core plan wholesale/retail frame allowance

Inform your patients that they must pay for services and/or materials provided if they:

Aren’t eligible for the services/materials requested;
Have Repair/Replace benefits but don’t meet the criteria for repair or replacement services/materials.

Authorizations

Contact VSP at 800.615.1883 to obtain an authorization for repair/replace benefits.

Expired Session

Error Encountered

Repair/Replace Benefits

Benefit Instructions

Authorizations