The ProTec Safety Plan will be offered to new clients seeking a safety plan and also to current VSP Safety Eyecare clients as they renew their contracts. With ProTec Safety, your patients can see you for their safety eyewear needs, which provide continuity of care for your patients.

Safety Requirements Questionnaire

ProTec Safety patients should complete a questionnaire about their work environments and related safety requirements before receiving safety services. You can use VSP’s Safety Requirements Questionnaire if you’d like or one you’ve created. Keep a copy of the completed questionnaire in your patients’ record.

Coordination of Benefits

There’s no coordination of benefits under the ProTec Safety plan.

ProTec Safety is a materials-only plan, so a safety exam isn’t typically covered. In some cases, ProTec Safety patients may have routine VSP coverage that covers their routine exam. Please refer to the Patient Record Report for exam coverage and benefit information because different patients may have different coverage.

To receive safety eyewear, the patient’s prescription must be under two years old. You can choose to require a new exam prior to providing materials based on your professional judgment. If you decide that an exam is necessary, deduct 20% from the exam.

Necessary corrective lenses (i.e. single vision, bifocal, trifocal, or lenticular) in glass or plastic (CR-39) that meet the American National Standards Institute (ANSI) standards are detailed below for safety eyewear.

ANSI Requirements

The lenses and frames provided under this plan are certified as safe for the work environment by meeting the necessary requirements set forth by ANSI effective April 13, 2010.

Lenses

Covered Lens Enhancements

Covered lens enhancements are available and will vary depending on the patient’s benefit. VSP will pay the lab for any covered lens enhancement and there’s no charge to the patient. Refer to the Patient Record Report for lens enhancement coverage. In most cases, ProTec Safety patients will be covered for polycarbonate lenses.

Other Enhancements

If your patient selects a lens enhancement that is covered with copay,charge the patient your usual and customary fee (U&C) for the lens enhancement or their lens enhancement copay. (refer to the VSP Signature Plan Lens Enhancement Chart), whichever is lower. Refer to the Patient Record Report for lens enhancement coverage.

Here are several examples of lens enhancements that patients can choose to purchase for safety eyewear:

Non-covered Items

These options and items aren’t covered under the ProTec Safety plan and VSP will deny the claim if submitted for reimbursement:

• Contact lenses
• Everyday eyewear instead of safety materials
• Materials obtained from a non-VSP doctor, unless the group has out-of-network coverage
• Plano or non-prescription lenses, unless otherwise indicated on the Patient Record Report (minimum prescription ±0.50 diopters required for lenses)

Frames

Covered Frames

ProTec Safety patients must choose one of the 30 ANSI-approved frames from the ProTec Eyewear kit or online catalog. ProTec Eyewear frames are fully-covered for the patient and will be supplied by a participating lab (see the Lab section for more details). Don’t charge patients for any frame overages.

Non-Covered Frames

Non-covered ProTec Eyewear frames can only be dispensed, if one of the following occurs:

• The needed eye size isn’t available in any of the covered frames
• None of the frames meets the hazardous work environment of your patient.
• The patient has an allergy to the standard safety frame materials used in the covered frames.

If a non-ProTec Eyewear frame is selected due to one of these circumstances, the frame is not covered in full. The patient will have a retail frame allowance of $65 (wholesale allowance of $25). If the member chooses a frame with a cost that exceeds both the wholesale and retail allowances, deduct 20% from the retail overageDetermine the patient’s cost (if any) as you do today and collect any overages from patient.

Additional Materials

When a complete pair of glasses, including plano sunglasses, is dispensed within 12 months from the date of the last eye exam, charge the patient 80% of U&C for non-covered materials. Refer to the Value-Added Benefits in the VSP Signature Plan^® section for details.

All ProTec Safety orders must be sent to a participating lab:

VSPOne Columbus
800.251.5150
2065 Rohr Road, Lockbourne, OH 43137

VSPOne Sacramento
800.952.5518
151 Blue Ravine Rd., Folsom, CA 95630

When billing electronically, eClaim will only offer these lab choices for ProTec Safety orders. If you don’t already have an account with the lab, you may submit the order, but they may contact you for more information.

Paper claim practices: You must order lab-supplied materials from the any of the participating labs listed above.

Emergency Situations

In emergencies, you can use any lab capable of producing ANSI certified safety eyewear (see the National Contract Lab List); choose lab 100 when billing on eClaim.

The following situations are considered emergencies. Include the reason for the emergency when submitting claims to VSP:

Use one of the following comments when indicating emergency status:

• Patient’s safety glasses are lost, stolen, or broken and he or she doesn’t own a back-up pair.
• Patient needs safety glasses to work or drive, is unable to see well enough to do so, and doesn’t have a back-up pair of safety glasses.
• Patient’s safety and well-being will be jeopardized without the immediate delivery of his or her prescription safety eyewear.

Lenses

You’ll receive a flat rate dispensing fee of $25 for covered lenses. There are no additional reimbursements for dispensing progressive lenses or covered lens enhancements Use CPT code 99022 (for shipping) when submitting for progressive lenses to be reimbursed up to the maximum allowable.

Frame

Patients must choose a covered ProTec Eyewear frame which will be supplied by a participating lab. You won’t receive a dispensing fee or material reimbursement for the frame. When submitting the claim, be sure to look for the Collection with ProTec next to it (i.e. Baseline Collection – ProTec) when entering frame information on EasyFind.

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