VSP Advantage Plan Lens Enhancement Charts
December 31, 2023 VSP Enhanced Advantage Plan Lens Enhancement Chart
June 27, 2023 VSP Advantage Lens Enhancements Chart
March 1, 2021 VSP Advantage Lens Enhancements Chart
Tools and Forms Index
- 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