The VSP Enhanced Advantage Plan is a new full-service plan that offers choice, flexibility, and value through a VSP Advantage Network Provider.

Coverage typically includes necessary prescription lenses and a frame up to a client-specified allowance, or an allowance toward contact lenses. Please review the patient’s coverage before providing materials.

Patients are also eligible for benefits on additional materials (see Value Added Benefits below).

Lenses

Spectacle lens coverage under the VSP Enhanced Advantage Plan is designed to provide necessary lenses covered in full. Your base lens payment includes your reimbursement for the following:

• Single vision, bifocal, trifocal, or lenticular lenses in plastic or glass
•  Eye sizes up to and including 60mm
•  Polycarbonate lenses for monocular patients, dependent children, and handicapped patients
•  Lined multifocal lenses in all segment widths, including occupational lenses. See the Dispensing & Patient Lens Enhancements section of the VSP Manual for specific details on occupational lenses
•  Prism and slab off
•  Base curves (regardless of curve)

Covered Lens Enhancements

If a patient chooses a covered lens enhancement, you’ll receive the VSP Enhanced Advantage Plan covered service fee. We won’t apply a charge back.

Other Lens Enhancements

Covered with Additional Copay: For lens enhancements that are covered with copay, charge the patient the patient copay listed on the VSP Enhanced Advantage Plan Lens Enhancement Chart or 80% of your U&C fees, whichever is lower, or the client-specific copay indicated on the Patient Lens Enhancement Report.

Flexible Lens Enhancements

To offer more customized coverage to clients and members, we’ve developed flexible lens enhancement programs that allow a client-specific copay or allowance for partial coverage for the most popular VSP lens enhancements, including anti-reflective (AR) coatings, photochromics, and progressives. Always refer to the online Patient Record Report and Lens Enhancements Charges report for complete information on lens enhancement coverage. The VSP Flexible Lens Enhancement Coverage Tip Sheet provides more information and helps you calculate patients' out-of-pocket expenses.

VSP Enhanced Advantage Plan patients receive a client-defined frame allowance, which is represented by a combination of the wholesale frame amount and corresponding retail amount for which your patient is covered. Although patients will only be informed of their retail allowance, they’re covered for any in-network (or covered) frame less than or equal to their wholesale or retail allowance. You receive your VSP Enhanced Advantage Plan frame dispensing and the wholesale cost up to their wholesale allowance, plus collect any overage according to our frame overage procedures.

Most patients with a VSP Enhanced Advantage Plan will have an extra $20 on top of their frame allowance when they select Marchon^® or Altair^® frames. Look for the retail / wholesale allowances for Marchon/Altair and all other frames indicated on the Patient Record Report at authorization.

Frame Overages

Charge the patient according to our frame overage procedures. When the selected frame exceeds both the wholesale and equivalent retail allowance coverage, your patient is responsible for the overages exceeding his or her retail frame allowance at 80% of U&C. Don’t charge your patient more than 80% of U&C on frame overage, plus any applicable sales tax.

For more information, refer to the Providing Frames section in the VSP Manual.

Other Frame Details

Bill all frames as “doctor supplied” since we’re paying you directly. Your practice is responsible for paying the lab for any lab-supplied frames.

There is no charge to patients for standard frame cases; however, you may charge patients for special orders or for deluxe frame cases.

VSP does not provide a dispensing fee when a patient-supplied frame is used and patients can’t be charged any additional fees.

Many clients provide coverage for contact lenses in lieu of prescription glasses. To be eligible for contact lens coverage, a patient must usually first be eligible for eyeglasses. Check the Patient Record Report for the patient's specific type of coverage and contact lens allowances. Refer to Contact Lens Benefits in the VSP Manual for more information.

Many clients provide coverage for Low Vision. Refer to the Low Vision section in the VSP Manual for more information.

The benefits below are considered a private transaction between you and your patient. Your patient is fully responsible for payment.

Exam Services

• Charge 80% of U&C on additional eye exams, including if only a refraction is performed.
• Is unlimited for 12 months on or following the date of the last eye exam.

Retinal Screening Value Added Feature

• Patients are eligible for routine retinal screening as a value added feature to complement their WellVision Exam^® benefit.
• Retinal screening: patients pay $39 or your U&C fee, whichever is lower.
• Please see the Retinal Screening section of the VSP Manual for more information. 

Glasses

Charge 80% of U&C for additional materials when complete pairs of prescription glasses and non-prescription sunglasses and blue light filtering glasses are dispensed within 12 months of the exam. This 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.
• Is available through any VSP doctor. Use professional judgment when evaluating prescriptions from another provider. You may request an additional exam at 80% of U&C fee.
• Applies to prescription and non-prescription lenses.
• Doesn’t apply to cleaning products or repairs of prescription lenses or frames.

Contact Lenses

Charge 85% of U&C on contact lens services. This benefit:

• Is subtracted from your U&C fee for evaluation, fitting, and follow-up services for prescription contact lenses.
• Is unlimited for 12 months on or following the date of the covered eye exam.
• Is available through any VSP doctor. Use professional judgment when evaluating prescriptions from another provider. You may request an additional exam at 80% of U&C.
• Doesn’t apply to lenses, solutions, cleaning products, and service agreements.

VSP Laser VisionCare^SM Program

Please see the Laser VisionCare^SM Program page under Plans & Coverages for plan details.

The VSP Enhanced Advantage Plan may also be sold with the following supplemental plans. Doctors are paid VSP Enhanced Advantage fees for the materials dispensing.

Enhanced Advantage Computer VisionCare^SM Plan

Note: If your patient chooses a covered lens enhancement, there’s no charge and you’ll receive the VSP Enhanced Advantage Plan covered service fee. If your patient selects any other lens enhancements, charge the patient according to the VSP Enhanced Advantage Plan Lens Enhancement Chart or 80% of your U&C fees, whichever is lower. You’ll be charged back the VSP Enhanced Advantage Plan lab fee for those lens enhancements.

See the VSP Computer VisionCare Plan section of the VSP Manual for more information.

Enhanced Advantage Additional Pair

Note: If your patient chooses a covered lens enhancement, there’s no charge and you’ll receive the VSP Enhanced Advantage Plan covered service fee. If your patient selects any other lens enhancements, charge the patient according to the VSP Enhanced Advantage Plan Lens Enhancement Chart or 80% of you U&C fees, whichever is lower. You’ll be charged back the VSP Enhanced Advantage Plan lab fee for those lens enhancements.

Reminder: Obtain a separate authorization for these plans and follow the plan information provided on the authorization.

Claims may be submitted on eClaim or on paper. See the Submitting Claims section in the VSP Manual for details.

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