There are two types of Safety EyeCare plans: the Safety Supplemental Plan and the Safety Stand-Alone Plan. Most clients that provide safety benefits purchase the Safety Supplemental Plan, in addition to our VSP Signature Plan^®.

The Safety Stand-Alone Plan is similar to our Signature Plan, with two exceptions:

• Prescribed materials must meet American National Standards Institute (ANSI) standards for safety eyewear.
• Value-Added benefits don’t apply to non-covered materials.

Safety Requirements Questionnaire

Safety EyeCare Plan patients should fill out questionnaires about their work environments and related safety requirements before exams. A sample Safety Requirements Questionnaire is located in the Tools and Forms section of the Manuals on VSPOnline on eyefinity.com. Keep a copy of the questionnaire or the information it contains in your patient’s record.

Coordination of Benefits

There’s no coordination of benefits under most Safety EyeCare Plans.

When your patient has Safety Supplemental coverage, use the patient’s Signature Plan coverage for a routine eye exam and the Safety Supplemental Plan for supplemental exams. Give an intermediate or comprehensive eye exam under your patient’s Safety Supplemental Plan only if that patient isn’t eligible for an eye exam under the Signature Plan.

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.

Certified safety eyewear, lenses and frames must meet the following standards set by ANSI, effective April 13, 2010:

Other Lens Enhancements

If your patient selects a lens enhancement that is covered with copay, . charge your patients the amount listed on the VSP Signature Plan Lens Enhancements Chart or your U&C, whichever is lower. Check the Patient Record Report.Examples of lens enhancements for patients:

Non-covered Items

The items below aren’t a benefit under the Safety EyeCare 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 (non-prescription) lenses (unless otherwise indicated)
• Rimless mounting

Frames

After determining patient eligibility and lens needs, have your patient choose a frame from your safety selection or the ProTec Eyewear^® online catalog. ProTec Eyewear offers ANSI Z87-2 certified frames in a variety of styles and colors, including Titanium and wrap-around. If your practice carries ProTec Eyewear, please note that the frames in the kit are for display purposes only. All ProTec Eyewear should be ordered through a participating lab and will be supplied by the labs.

Side shields and a frame case are included with ProTec Eyewear frames at no additional cost. If a client requires permanent side shields, a comment on the Patient Record Report will indicate the requirement.

Under the Safety EyeCare plan, patients can choose a frame with detachable or permanent side shields. If the frame and shields are priced separately, add the cost of the shields to the cost of the frame to determine the total cost. Depending upon the patient’s frame allowance, ProTec Eyewear frames may not be fully covered under the VSP Safety EyeCare Plan. Refer to the Patient Record Report for more information on the patient’s frame allowance. Overages should be determined using the VSP Signature Plan frame overage policy

All safety orders must be sent to a participating lab:

VSPOne Columbus
800.251.5150
2605 Rohr Road, Lockebourne, OH 43137

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

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

Emergency

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.

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 and 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.

Supplemental Safety EyeCare Exams

The level of eye exam or the evaluation and management service that you provide depends on the location and the time elapsed since the patient’s last routine eye exam:

When possible, perform your supplemental and comprehensive or intermediate exams in the same visit.

*If you choose to use 920XX codes to bill your WellVision Exams, please remember to bill refraction (92015) separately for accurate reimbursement.

Stand-Alone Safety EyeCare Plan Exams

Exams for Stand-Alone Safety EyeCare Plans are reimbursed at your Signature Plan comprehensive or intermediate exam payable fee.

Dispensing Fees

Supplemental Safety EyeCare Plans have a lens dispensing fee only. The lens dispensing is reimbursed at a flat rate of $25.

Stand-alone Safety Eyecare Plans have a lens and frame-dispensing fee that is also reimbursed at a flat rate. Both lens and frame dispensing are reimbursed at $25 each.

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