Eligibility & Authorization
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Copays
We’ll indicate copays when you obtain authorization.
Note:
Don’t waive copays.
Coordination of Benefits (COB)
With the exception of the secondary allowances, the VSP Advantage Plan and VSP Essentials Plan COB guidelines are the same as the VSP Signature Plan. For additional information, see Coordination of Benefits in the VSP Manual.
The following table shows you how to use the secondary plan to coordinate benefits based on your network participation.
| Patient’s primary plan | Patient’s secondary plan | Your network participation is | Then |
| VSP Advantage Plan or VSP Essentials Plan | VSP Signature Plan | Advantage Network | You’ll be reimbursed based on the VSP Signature Plan COB allowances. (See COB rules for exceptions). |
| VSP Advantage Plan or VSP Essentials Plan | VSP Signature Plan | Non-Advantage Network | We’ll reimburse the patient based on the VSP Signature Plan non-VSP provider reimbursement schedule if out-of-network coverage is available. |
| VSP Signature Plan | VSP Advantage Plan or VSP Essentials Plan | Advantage Network | You’ll be reimbursed according to the Advantage Coordination of Benefits Secondary Allowances. |
| VSP Signature Plan | VSP Advantage Plan | Non-Advantage Network | We’ll reimburse the patient based on the VSP Advantage Plan non-VSP provider reimbursement schedule if out-of-network coverage is available. |
| VSP Signature Plan | VSP Essentials Plan | Non-Advantage Network | We’ll reimburse the patient based on the VSP Essentials Plan non-VSP provider reimbursement schedule if out-of-network coverage is available. |
| VSP Advantage Plan or VSP Essentials Plan | VSP Choice Plan | Advantage Network | You'll be reimbursed based on the VSP Choice Plan COB allowances (See COB rules for exceptions.) |
| VSP Advantage Plan or VSP Essentials Plan | VSP Choice Plan | Non-Advantage Network | We'll reimburse the patient based on the VSP Choice Plan non-VSP provider reimbursement schedule if the out-of-network coverage is available. |
| VSP Choice Plan | VSP Advantage Plan or VSP Essentials Plan | Advantage Network | You’ll be reimbursed according to the Advantage Coordination of Benefits Secondary Allowances. |
| VSP Choice Plan | VSP Advantage Plan | Non-Advantage Network | We’ll reimburse the patient based on the VSP Advantage Plan non-VSP provider reimbursement schedule if out-of-network coverage is available. |
| VSP Choice Plan | VSP Essentials Plan | Non-Advantage Network | We’ll reimburse the patient based on the VSP Essentials Plan non-VSP provider reimbursement schedule if out-of-network coverage is available. |
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