Exam Coverage

Covered comprehensive eye exams are generally available to your patient once every 12 or 24 months on a service year, fiscal year, or calendar year basis. Provide the level of exam necessary to determine your patient’s eye health and visual status.

Advantage Exam Plus Plan and Advantage Exam Plus with Allowances Plan eye exam fees are made according to your Advantage Network Fee Schedule.

We’ll pay exam services once per eligibility period. Don’t balance bill for exams.

Materials Coverage

Advantage Exam Plus and Advantage Exam Plus with Allowances patients are entitled to savings on glasses and contact lens services. Advantage Exam Plus with Allowances patients are eligible for additional materials benefits based on a client-determined schedule of allowances. Refer to Exam Plus and Exam Plus with Allowances in the VSP Manual for more information.

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

• Plan Reference Chart
• CMS-1500 Claim Form Quick Reference Card
• Computer VisionCare Questionnaire
• Coordination of Benefits Acknowledgement
• Explanation of Payment Quick Reference Guide
• First-Time Redo Verification Form
• Frame Benefit Examples/Frame Calculator
• Interactive Voice Response Quick Reference Card
• Low Vision Verification Form
• Material Invoice Form
• Materials Invoice Quick Reference Card
• Materials Verification Form
• Member Complaint/Grievance Forms (National/California-Only/California-Spanish/California-Chinese)
• Patient Exam Form
• Patient History Questionnaire
• Patient Responsibility Statement Form
• Primary Care Provider Communication Form
• Provider Dispute Resolution Request & Multiple Provider Dispute Resolution Forms
• Safety Requirements Questionnaire
• Vision Benefit Statement
• Vision Therapy Verification Form (ICD-10)
• VSP Savings Statement (with 20% discount) (without discount)
• Current VSP Signature Lens Enhancements Chart