Repair/Replace Benefits
Repair/Replace Benefits cover materials your patients get when they’re not eligible for materials under their core plan. Refer to the Patient Record Report to determine if the patient is eligible for repair or replacement coverage. Patients are eligible if their spectacle lenses or frames are broken or damaged and need repair or replacement.
It also covers materials your patients receive when they’re not eligible for materials under the core plan and they can no longer use their glasses.
Patients covered under this additional benefit may be entitled to eyeglass lens and frame repair. Frame repair includes temples only, front only, hinge, and miscellaneous repairs. The Repair Benefit may also include replacement of a complete frame and/or basic lens.
Benefit Instructions
- Patients need to bring the glasses to you before obtaining an authorization.
- You’ll determine if glasses can be repaired. If they can’t, replacement may be covered.
|
Exam |
Lenses |
Frames |
|
Exams aren’t covered. |
New lenses are allowed if:
Note: Contact lens repair or replacement isn’t covered under this plan. |
Replacement parts are covered if:
Replacement of the complete frame is covered if:
|
Inform your patients that they must pay for services and/or materials provided if they:
- Aren’t eligible for the services/materials requested;
- Have Repair/Replace benefits but don’t meet the criteria for repair or replacement services/materials.
Authorizations
Contact VSP at 800.615.1883 to obtain an authorization for repair/replace benefits.