The following client details apply to Moda Health Medicare Advantage (Moda Health PPO and Moda Health Plan Medicare Supplement patients only). Refer to VSP Advantage Plan section for complete coverage details not listed below.

Lenses

Spectacle lens coverage under the VSP Advantage Plan is designed to provide necessary lenses covered in full, including single vision, bifocal, trifocal, or lenticular lenses in plastic or glass. You’ll receive your Advantage Plan lens dispensing fee for covered lenses.

Lens Enhancements

Members are covered for standard progressives, scratch coating and UV protection. If a patient chooses a covered lens enhancement, you’ll receive the Advantage Plan covered service fee. If your patient selects a con-covered lens enhancement, charge the patient according to the VSP Advantage Network Lens Enhancements Chart.

Lab

All orders must be sent to VSPOne^™ Columbus. In--office finishing equipment may not be used.

Only in an emergency situation may a private lab be used. See Using Non-Contract Labs for more information. If a non-contract lab is used for an emergency situation, the non-Genesis frame allowance would apply.

Covered Frame

Frames from the Altair^® Genesis collection are covered for patients and will be lab supplied through VSPOne™ Columbus. You’ll receive a $19 frame dispensing fee. To ensure correct frame dispensing payment, enter both wholesale and retail frame amounts and choose lab supplied frame option. Genesis frames are fully covered when a complete pair of prescription glasses (lenses and frame) is ordered. Genesis frame only orders would be a private transaction and the frame will not be covered by VSP.

You can also use Genesis frames to meet the needs of non-Moda Health Plan patients. Order frames through Altair just as you do today. To inquire or request Genesis frames, contact Altair at 800.505.5557.

Other Frames

A patient has the option of supplying their own frame or purchasing a non-Genesis frame from you. The non-Genesis retail frame allowance is $50. We’ll pay you up to 55% of the patient’s retail frame allowance. When the frame exceeds the retail allowance, charge the patient 80% of the retail price exceeding the allowance. Regardless of the frame brand that’s purchased, the benefit for lenses will still follow Advantage Plan pricing (see Lenses section above). In-office finishing equipment or stock lenses may not be used.

Contact Lenses

Patients may select contact lenses instead of glasses. Please refer to the Patient Record Report for details.