VSP’s Access Plan is a vision savings program on an eye exam and eyewear through a VSP network provider. The Access Indemnity Plan combines the Access Plan with an indemnity schedule of allowances, established by the client.

Eligibility & Authorization

Eligibility can be obtained on eyefinity.com or by calling VSP at 800.615.1883.

Exam Services

• Patients are eligible for eye exams, including if only a refraction is performed at 80% of U&C.
• Coverage only applies to services and procedures included in a WellVision^® Exam. It doesn’t apply to additional diagnoses and treatment.

Materials

Charge patients 80% of U&C for frames, lenses, and lens enhancements when a complete pair of prescription glasses or non-prescription sunglasses is dispensed. The benefit:

• Is unlimited for 12 months on or following the date of an eye exam from a VSP doctor.
• Doesn’t apply to cleaning products or repairs of prescription lenses or frames.

When dispensing materials, use professional judgment in evaluating prescriptions from another doctor. If necessary, you can request additional routine exams at 80% of U&C

Contact Lens Services

Charge patients 85% of U&C for contact lens exam services (F&E) and follow-up services. The benefit:

• Applies to services for prescription contact lenses only.
• Is unlimited for 12 months on or following the date of an eye exam from a VSP Network Doctor.
• Doesn't apply to contact lens materials, solutions, cleaning products or service agreements.

The benefits are considered a private transaction between you and your patient; your patient is responsible for paying for the services or materials.

VSP Laser VisionCare^SM Program

• The program includes access to either Photorefractive Keratectomy (PRK) or Laser In-Situ Keratomileusis (LASIK) at a reduced cost, up to a maximum fee to the patient of $1,500 per eye for PRK, $1,800 per eye for LASIK, and $2,300 per eye for Custom LASIK with wavefront technology using the microkeratome, Custom PRK, or Bladeless LASIK.
• Members receive a complimentary screening as well as preoperative, and postoperative services through participating VSP doctors.
• If the laser center is offering a temporary price reduction, VSP members will get 5% off the advertised price if that’s less than the usual discount price.
• Please see the Laser VisionCare section under Programs on VSPOnline on eyefinity.com for information on how to participate or for a list of participating facilities.

Eligibility & Authorization

Eligibility can be obtained on eyefinity.com or by calling VSP at 800.615.1883.

Allowances are paid by us only once during each eligibility period.

Exam Coverage

• Patients are eligible for an eye exam and additional eye exams, including if only a refraction is performed at 80% of U&C. However, the allowance schedule applies only once.
• Coverage only applies to services and procedures included in an eye exam. It doesn't apply to additional diagnoses and treatment.
• Deduct 20% from the exam first, then apply the allowance.

Materials Coverage

Patients are eligible for prescription lens, lens enhancements and/or frame (complete pair not required) at 80% of U&C, plus a group-specific schedule of allowances. The benefit:

• Is unlimited for 12 months on or following the date of the last covered eye exam.
• Doesn't apply to cleaning products or repairs of prescription lenses or frames.
• Deduct 20% from the materials first, then apply the allowance.

When dispensing materials, use professional judgment in evaluating prescriptions from another doctor. If necessary, you can request additional routine exams at 80% of U&C

Contact Lenses Services & Materials

Patients are eligible for contact lens exam services (evaluation/fitting services and follow-up services) at 85% of U&C. You may charge your U&C fees for contact lens materials. Elective or visually necessary contact lenses are chosen in place of a complete pair of prescription glasses. You may bill the patient for any fees over the allowance and any applicable copay amount. The benefit:

• Applies to services for prescription contact lenses only.
• Is unlimited for 12 months on or following the date of the last covered eye exam, however the allowance schedule apples only once.
• Use professional judgment when evaluating prescriptions from another doctor.
• Doesn't apply to contact lens materials, solutions, cleaning products or service agreements.
• Deduct 15% from contact lens exam services (F&E) charge, then add your U&C fees for contact lens materials and apply the allowance.

When dispensing materials, use professional judgment in evaluating prescriptions from another doctor. If necessary, you can request additional routine exams at 80% of U&C.

Lab

Lab work is handled privately. You may provide lenses through any lab, including in-office labs.

Value-Added Benefits

The value-added benefits below are considered a private transaction between you and your patient; your patient must pay for any additional items:

• Patients are eligible for additional complete pairs of prescription glasses or non-prescription sunglasses and blue light filtering glasses, from any VSP doctor within 12 months of the last eye exam at 80% of U&C. The benefit:
  • Is based on your total U&C fee.
  • Is unlimited for 12 months on or following the date of the last covered eye exam.
  • Use professional judgment when evaluating prescriptions from another doctor.
  • You can request an additional routine exam at 80% of U&C.
  • Doesn't apply to cleaning products or repairs of prescription lenses or frames.
• Patients are eligible for contact lens exam services (evaluation/fitting services and follow-up services) at 85% of U&C. The benefit:
  • Is based on your total U&C fee.
  • Applies to services for prescription contact lenses only.
  • Is unlimited for 12 months on or following the date of the last covered eye exam.
  • Use professional judgment when evaluating prescriptions from another doctor.
  • Doesn't apply to solutions, cleaning products or service agreements.

VSP Laser VisionCare^SM Program

• The program includes access to either Photorefractive Keratectomy (PRK) or Laser In-Situ Keratomileusis (LASIK) at a reduced cost, up to a maximum fee to the patient of $1,500 per eye for PRK, $1,800 per eye for LASIK, and $2,300 per eye for Custom LASIK with wavefront technology using the microkeratome, Custom PRK, or Bladeless LASIK.
• Members receive a complimentary screening as well as preoperative, and postoperative services through participating VSP doctors.
• If the laser center is offering a temporary price reduction, VSP members will get 5% off the advertised price if that's less than the usual discount price.

VSP Access Plan^®

Apply the VSP Access Plan vision savings, as follows: exam at 80% of U&C; glasses at80% of U&C; contact lens exam at 85% of U&C. Handle the visit as a private pay transaction. Don’t submit a claim to VSP. Collect the appropriate fees from the patient.

VSP Access Indemnity Plan^SM

• Apply the vision savings noted above for VSP Access Plan to your U&C professional fees.
• Subtract your patient’s Access Indemnity Plan allowance (found on the Patient Record Report) from adjusted U&C fees.
• Bill your patient for the difference between your adjusted U&C fees and the indemnity allowance.
• Bill VSP for services.
• Your patients may use their benefits for prescription glasses (lens and/or frame) or contact lens fitting/materials.
• For your patients with combined allowances, bill all services at the same time so your patients get their full benefits.

Glasses: Bill using eClaim.

• Complete the Invoice Services page and select “Non-VSP lab (Private Invoice).”
• Click on the “Calculate HCPCS and Continue” button.
• Complete the Diagnosis and Services page by entering your full U&C fees next to the appropriate CPT/HCPCS code.

Contact Lenses: Bill using eClaim.

• Choose the type of contacts dispensed.
• Click on the “Calculate HCPCS and Continue” button.
• Complete the Diagnosis and Services page by entering your full U&C fees next to the appropriate CPT/HCPCS code.
• Please see the Necessary Contact Lens Benefit Criteria section of your VSP Provider Reference Manual for more information regarding benefit criteria and claim submission.

Following is an example of an exam, prescription lenses and frame provided under the VSP Access Indemnity Plan. The indicated U&C fees and indemnity allowance amounts are examples only.

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