Please check eligibility for routine services with VSP first for Cigna members to ensure claims are billed to the appropriate insurance carrier as some members may have routine benefits directly through Cigna. If benefits can’t be verified with VSP, apply the Cigna Healthy Rewards-Vision Network Savings Program savings, charge the patient, and advise him or her to contact Cigna to find out if the claim can be submitted directly to Cigna.

Some Cigna Vision members may also have dual coverage. They may have a full service VSP plan and a Cigna Vision Choice Exam Plus plan. Comment codes will alert you that the member may have dual coverage. If dual coverage does exist, check eligibility using the last 4 digits of the primary member’s SSN, instead of the Cigna ID number.

Cigna Vision has some exceptions to coverage that are slightly different than our other plans. The Patient Record Report (a.k.a. authorization) will indicate the following exceptions:

Polycarbonate lenses

These lenses are covered for children under the age of 19. The authorization will indicate them as a covered lens enhancement.

Oversize lenses

These lenses are covered regardless of the eye size.

Value Added Benefits

Cigna Vision members qualify to receive a savings on exams and contact lens services through the Cigna Healthy Rewards Vision Network Savings Program. Members also receive lenses and lens enhancements at 80% of U&C, and frames at 75% of U&C even when a complete pair of glasses isn’t ordered. Please refer to the Cigna Healthy Rewards-Vision Network Savings Program Client Detail Page for more detailed information.

Allowance Plans - Remaining Allowance

Cigna Vision members with an Exam Plus or Access Indemnity plan, with a combined material allowance, can apply any unused portion of the material allowance at a later date, within the same eligibility period (i.e. calendar year), to additional materials or services. Some exceptions may apply. See the Patient Record Report for any client exceptions Members can’t carry forward balances from a past eligibility period. Call VSP at 800.615.1883 to determine available allowances and to obtain an authorization.

Material copays don’t apply to visually necessary contact lenses. Don’t collect material copays from patients receiving visually necessary contact lenses, unless indicated in special comments.

We reimburse for services or materials provided to Cigna Vision members four times a month. Your normal Explanation of Payment (EOP) shows your Cigna Vision patients. In addition to your standard EOPs, you may receive an EOP for additional payment cycles, if you billed VSP for services or materials for a Cigna Vision Patient. For questions, call VSP at 800.615.1883.

The following Cigna Vision clients have unique exceptions as indicated below.

Progressive Lenses

If the patient orders progressive lenses, they have an $80 progressive lens allowance. The authorization includes a comment code, indicating the allowance amount. If progressive lenses are ordered, subtract the allowance and bill your patient the remaining balance. You may use any lab on a private invoice basis.

Lab Selection Instructions

To choose a lab on eClaim:

• VSP contract lab - to send the order to a VSP contract lab, simply enter the lab ID number in the lab ID field in eClaim. This is a private transaction between your office and the lab. You’ll receive a lab bill.
• Non-VSP contract lab - to send the order to a non-VSP contract lab, choose lab 100 from the eClaim drop down menu. Also submit your lab order directly to the lab of your choice. eClaim won’t forward your order to any lab. This is a private transaction between your office and the lab. You’ll receive a lab bill.

Lens Enhancements

If your patient selects progressive lenses and also orders covered lens enhancements, don’t charge your patient for the lens enhancements. You’ll receive both the covered service fee and the VSP Choice Plan^® chargeback fee (we usually pay this fee to the lab) for the covered lens enhancement(s) provided. Please refer to the VSP Choice Plan Lens Enhancements Chart. Please note, if there are no service fees or charge back amounts listed (i.e., rimless mounting, pink tints 1and 2), the lens enhancement is considered covered in the allowance and no additional payment will be made.

If other lens enhancements are ordered with the progressive lens, bill the patient 80% of U&C for this enhancement.

Allowances

This plan has a $300 combined allowance for any combination of exam, lenses, lens enhancements, frames, and contacts. Apply allowance to adjusted U&C for exam, glasses, and contact lens services. You may bill the patient the remaining balance.

Progressive Lenses

This plan has a $70 allowance for progressive lenses, with a $40 copay. The authorization includes a comment code, indicating the allowance amount. If progressive lenses are ordered, subtract the copay from your adjusted U&C fees, and then subtract the $70 progressive allowance. Bill your patient the remaining balance. You may use any lab on a private invoice basis.

Lab Selection Instructions

To choose a lab on eClaim:

• VSP contract lab - to send the order to a VSP contract lab, simply enter the lab ID number in the lab ID field in eClaim. This is a private transaction between your office and the lab. You’ll receive a lab bill.
• Non-VSP contract lab - to send the order to a non-VSP contract lab, choose lab 100 from the eClaim drop down menu. Also submit your lab order directly to the lab of your choice. eClaim won’t forward your order to any lab. This is a private transaction between your office and the lab. You'll receive a lab bill.

Lens Enhancements

If your patient selects progressive lenses and also orders covered lens enhancements, don’t charge your patient for the lens enhancements. You’ll receive both the covered service fee and the VSP Choice Plan chargeback fee (we usually pay this fee to the lab) for the covered lens enhancement(s) provided. Please refer to the VSP Choice Plan Lens Enhancements Chart (see exception below).

Exception: rimless mount and pink 1 and 2 tints are considered part of the allowance. No additional payment will be made for these enhancements.

If other lens enhancements are ordered with the progressive lens, charge the patient 80% of your U&C.

Contact Lens Coverage

In addition to a routine WellVision exam, patients are also covered for contact lens services (fitting and evaluation). Patients can choose to use their benefits towards an exam, contact lens services (fitting and evaluation) and either glasses (lens and frame) or contact lenses.

The contact lens allowance is based on the type of contact lenses that are dispensed. For non-disposable contacts, the allowance is $180. For disposable contacts, the allowance is $230.

Contact lens materials are eligible once per lifetime. The patient can receive contact lens materials and a frame in the same eligibility period.

Visually Necessary Contact Lenses

This plan has a $230 allowance for necessary contact lenses. Follow normal procedures to determine if the patient meets the visually necessary contact lens criteria and bill your patient the remaining balance. The patient is covered in full for contact lens services (fitting and evaluation). Use the patient's Additional Pair benefit to bill the contact lens services.

Contact lens coverage

In addition to a routine WellVision exam, patients are also covered for contact lens services (fitting and evaluation). Patients can choose to use their benefits towards an exam, contact lens services (fitting and evaluation), and either glasses (lens and frame), or contact lenses.

Visually Necessary Contact Lenses

This plan has a $170 allowance for both visually necessary contact lenses and elective contact lenses (ECL). If your patient requires visually necessary contact lenses, bill as elective contact lenses. Apply the allowance to 85% of your U&C for the contact lens services (fitting and evaluation) fees and your U&C for contact lens material fees. Bill your patient the remaining balance.

Progressive lenses

All progressive lenses are covered with a $40 copay.

Claim Submission

Please include all services and/or materials, when submitting claims for SEIU members, including those not covered by their Cigna Vision benefits (additional pairs, etc.). The charges can be added to the FSA field on eClaim. Refer to the Flexible Spending Account section in the VSP Manual for more information.

SEIU - Union Plan

Visually Necessary Contact Lenses

This plan has a $40 allowance for both visually necessary contact lenses (NCL) and elective contact lenses (ECL). If your patient requires visually necessary contact lenses, bill as elective contact lenses. Apply the allowance to 85% of your U&C for the contact lens services (fitting and evaluation) fees and your U&C for contact lens material fees. Bill your patient the remaining balance.

Progressive lenses

All progressive lenses are covered with a $50 copay.

Claim Submission

Please include all services and/or materials, when submitting claims for SEIU members, including those not covered by their Cigna Vision benefits (additional pairs, etc.). The charges can be added to the FSA field on eClaim. Refer to the Flexible Spending Account section in the VSP Manual for more information.

Progressive lenses

This plan has a $105 allowance for progressive lenses. The authorization includes a comment code, indicating the allowance amount. If progressive lenses are ordered, subtract the allowance from 80% of your U&C fees. Bill your patient the remaining balance. You may use any lab on a private invoice basis.

Lab Selection Instructions

To choose a lab on eClaim:

• VSP contract lab - to send the order to a VSP contract lab, simply enter the lab ID number in the lab ID field in eClaim. This is a private transaction between your office and the lab. You'll receive a lab bill.

Non-VSP contract lab - to send the order to a non-VSP contract lab, choose “lab 100” from the eClaim drop down menu. Also submit your lab order directly to the lab of your choice. eClaim won't forward your order to any lab. This is a private transaction between your office and the lab. You'll receive a lab bill.

Lens Enhancements

If your patient selects progressive lenses and also orders any covered lens enhancements, don't charge the patient for the lens enhancements. You’ll receive both the covered service fee and the VSP Choice Plan chargeback fee (we usually pay this fee to the lab) for the covered lens enhancement(s) provided. Please refer to the VSP Choice Plan Lens Enhancements Chart. Please note, if there are no service fees or charge back amounts listed (i.e. rimless mounting and pink tints 1&2), the lens enhancement is considered covered in the allowance and no additional payment will be made

If other lens enhancements are ordered with the progressive lens, charge the patient 80% of U&C for the lens enhancement.

Allowances

This plan has a $999.98 combined allowance for any combination of exam, lenses, lens enhancements, frames, and contacts. Apply allowance to adjusted U&C for exam, glasses, and contact lens services. You may bill the patient the remaining balance. Remaining balance may be used later if not exhausted with first claim. Call VSP Provider Services to determine remaining allowance and issue auth.

Frequency

Member and dependents are available for the full allowance every January 1st of even numbered years. Call VSP Provider Services at 800.615.1883.

Cigna has some clients that cover services in full for members under the age of 19 and/or members 19 and over.

The plans can be VSP Choice, Exam Plus with Allowance, or Access Indemnity. The coverage is identified with a comment code that indicates patients are covered in full for one pair of glasses or a one year supply of disposable contacts or one pair of conventional contacts, including the contact lens services (fitting and evaluation).

Contact lens materials will be reimbursed according to the Covered Contact Lens plan. The contact lens services will be reimbursed at 85% of your U&C fees. Dispensing an annual supply at one time is required under these plans. VSP should only be billed for an annual supply of lenses and shouldn't be billed for additional lenses. Additional lenses should be handled as a private transaction between you and the patient.

Full pair of glasses will be reimbursed at 80% of your U&C fees, including lens enhancements. Covered lens enhancements include - Oversize, UV coating, scratch coating, polycarbonate and tints (solid & plastic gradient).