VSP® Eyes of Hope® Gift Certificates
VSP Eyes of Hope gift certificates ensure adults and children in need, including those affected by disaster, can access quality eye care and prescription glasses at no cost through a local VSP network doctor. The certificates are distributed through our national network of charitable partners, including the American Red Cross, Lions Clubs, National Association of School Nurses, and Prevent Blindness. As a Choice Network doctor, you’ll be reimbursed when you see patients with a certificate. Learn more at vspproviderhub.com/eyes-of-hope.
VSP Eyes of Hope offers two types of charitable gift certificates that provide no-cost eye exams and glasses through Choice Network doctors for adults and children who qualify:
- VSP Eyes of Hope gift certificates are distributed to adults and children in need through national and regional strategic partners and at local outreach events with charitable and community partners throughout the U.S. Gift certificates provide access to an exam, frame, and lenses. People who have coverage for an exam through another means, but not for frames and lenses, can use a gift certificate to get the prescription glasses they need.
- Disaster Relief gift certificates are distributed through the American Red Cross and VSP Eyes of Hope mobile clinics to adults and children who need eye care or have lost or damaged their glasses during a disaster.
Patients have been pre-qualified by a charitable partner to meet program eligibility, and your practice will be reimbursed for the eye care and glasses you provide just as if the patient is a VSP member with a VSP Choice Plan®. Please review the following information carefully, for details on what is covered.
If you are not currently a Choice Network provider, please refer the patient back to VSP at 800.877.7195 to find a participating provider.
If you have any questions about the program, call VSP Customer Care at 800.615.1883.
How to Process a Gift Certificate
Check Validity
Each patient may use one gift certificate every 12 months; patients must present a gift certificate within the expiration date to receive charitable services. The date format printed on the gift certificates is in the YYYY.MM.DD format. For example, 2022.06.01 is June 1, 2022. Please check to make sure the certificate is being redeemed before the expiration date noted on the front and refer the patient back to the partner organization to obtain a new gift certificate if necessary. Unfortunately, VSP can’t accept claims on expired gift certificates, and the expiration dates cannot be extended.
Check Patient Eligibility
If patient has a Social Security number (SSN), check whether the patient has active coverage by using the “Member Search” button through eClaim on Eyefinity® or by calling VSP customer service. Only the last four digits of the SSN are required. If no patient record appears, or if the patient does not have an SSN, proceed to the next step to validate the gift certificate. However, having an SSN is no longer a requirement for the individual to receive services or for the doctor to be compensated. Any discussion involving the SSN will be between the doctor and patient.
NOTE:
A patient who does not have an SSN will not be a member in the VSP system.
Get an Authorization Number
- From the eInsurance tab, select the “Gift Certificate” button, enter the letters “GC” followed by the gift certificate number printed on the front (example: GC0000001), and click “GO.”
- Create the patient record using the pre-printed “Patient ID” number on the front.
- Once the patient record has been created, check benefits covered via the VSP Provider Reference Manual for Choice or the “Patient Record” tab in eInsurance.
NOTE:
It may take 10-15 minutes after the authorization is created for the data to display.
How to get an authorization number with a ‘Patient ID’ instead of a Social Security number (SSN)
A ‘Patient ID’ number is pre-printed on the gift certificates. This number is to be entered into the Patient ID field in eInsurance.
Submit a Claim
Electronic claims
Submit the claim as you would for any VSP plan.
Paper claims
Keep a copy of the certificate in your patient’s file. Call 800.615.1883 if you have questions about submitting a paper claim.
Exam only - Submit the original certificate to us with a completed CMS-1500 claim form.
Exam and materials for Disaster Relief and VSP Eyes of Hope gift certificates – Submit the original certificate, a completed CMS-1500 claim form, and a completed VSP Materials Invoice form to a VSP wholly-owned lab. Please follow all other normal lab processing procedures; reserve private lab use for emergencies only.
NOTE:
Use Patient ID number in place of SSN on the CMS-1500 claim form. See instructions in ‘Get an Authorization Number’ section above.
Select Eyewear
VSP Eyes of Hope gift certificates, including Disaster Relief gift certificates, cover any Marchon® or Altair® frame brand less than or equal to a $57 wholesale or $150 retail allowance. Brands with fully covered frames include Marchon NYC and Lenton and Rusby. Extra $20 does not apply.
While patients do receive a 20% discount on the overage when selecting a frame over the wholesale and retail allowance, the intent is to cover a frame in full whenever possible.
To add Marchon and Altair frames to your dispensary covered by the program, please contact your Account Executive. The collections can be viewed at marchon.com and altaireyewear.com
Lens benefits are noted in the section below.
Waive Sales Tax Collection
Because VSP Eyes of Hope gift certificate programs are designed to provide a comprehensive eye exam and prescription glasses at no cost to those in need, VSP strongly encourages all VSP network doctors not to collect sales tax from these patients for covered materials.
Archive the Gift Certificate
Save a copy of the gift certificate in your patient’s file.
Eligibility and Benefits for Each Type of Gift Certificate
The below information relates to each specific gift certificate type. Verify the coverage before providing services to ensure that you’ll be reimbursed.
Eye care services and prescription eyewear are not available if already covered through a private insurer and/or a government program such as Medicaid.
Children covered by the VSP Access Plan may qualify if they meet all other eligibility criteria. Need clarification? Call VSP.
Only one gift certificate can be redeemed in any 12-month period. Glasses that are lost, stolen, or broken within 12 months after a previous certificate is redeemed won’t be covered or replaced.
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VSP Eyes of Hope gift certificates are distributed to adults and children in need through charitable and community partnerships within the U.S. Gift certificates provide access to an exam, frame, and lenses for all ages. Vision therapy benefits and some lens enhancements are covered for individuals 19 years old and younger. |
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Eligibility |
To use this gift certificate, the patient must:
If the patient has coverage for a routine exam but not materials, bill the exam through other vision insurance and use the gift certificate for materials only. Glasses that are lost, stolen, or broken within 12 months after a certificate is redeemed can’t be covered or replaced. |
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Exam/ProfSvcs |
Covered - Every 12 months |
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Lens |
Covered - Every 12 months if manufacturer is "Generic" or "VSP" If manufacturer is not "Generic" or "VSP" it is "Not Allowed" |
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Frame |
Covered - Every 12 months |
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Benefit |
VSP Choice Plan® |
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Network |
Choice |
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Lab Use |
Must be processed through an approved VSPOne® Technology Center (Lab) from the eClaim drop-down menu. Please follow all other standard lab processing procedures; reserve private lab use for emergencies. |
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Low Vision |
Criteria applies. Please see Low Vision in the Plans & Coverages section for further information. |
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Vision Therapy |
For individuals 19 years old and younger only. Criteria applies. Please see Vision Therapy in the Plans & Coverages section for further information. |
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Coordination of Benefits |
COB rule 9: COB isn't allowed. Call VSP at 800.615.1883 for client exceptions and specific instructions. |
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Retinal Screening |
Charge the lesser of $39 or U&C |
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Co-Payments |
Exam $0, Lens $0, Frame $0 |
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Frame Allowance |
Frames are covered up to $150.00 (wholesale $57) for Marchon® and Altair® Eyewear brands frames. If the frame exceeds wholesale and retail allowance, the patient pays the retail overage. If the frame exceeds wholesale and retail allowance, the patient pays the retail overage after a 20% discount. For patient-supplied frames: Patient may re-use their own existing frame; doctor can bill on Eyefinity as patient supplied. If patient chooses a new non-Marchon or non-Altair frame, the frame is not covered by VSP under this program and patient is responsible for the cost of the frame. If you need to add Marchon and Altair frames to your dispensary that are covered by the program, please contact your Sales Representative or Customer Service: Marchon (800) 645-1300/Altair (800) 505-5557. The collections can be viewed at marchon.com and altaireyewear.com. |
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Necessary Contact Lenses (NCL) |
Criteria applies. Please see Necessary Contact Lenses in the Plans & Coverages section for further information. Copay $0. |
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Value Added Benefits |
20% off a complete additional pair of glasses, including plano sunglasses, from a VSP doctor within 12 months of routine exam. 15% off contact lens exam services from a VSP doctor for 12 months on or following date of routine exam. |
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LENS ENHANCEMENT DETAILS |
Polycarbonate lenses are covered for patients 19 years old or younger, and for adults (ages 20 and above) with monocular vision (Call 800.615.1883 to obtain authorization for Polycarbonate lenses for monocular prescriptions). Please see Lenses on Materials Coverage section for more information. Lens enhancements listed as “N” or “Non-covered” are not available to the patient and will invalidate the materials portion of the claim. If a claim is submitted with non-covered lens enhancements, the provider will be responsible for the lab bill and for the entire cost of all materials. |
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Anti-reflective Coatings |
N/A - Not Allowed for age 20 and above Covered for age 19 and below with Additional Copay if manufacturer is "Generic" or "VSP" If manufacturer is not "Generic" or "VSP" it is "Not Allowed" |
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Aspheric (plastic & digital) |
Covered with Additional Copay if manufacturer is "Generic" or "VSP" If manufacturer is not "Generic" or "VSP" it is "Not Allowed" |
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Blended Bifocal |
N/A - Not Allowed for age 20 and above Covered for age 19 and below with Additional Copay if manufacturer is "Generic" or "VSP" If manufacturer is not "Generic" or "VSP" it is "Not Allowed" |
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Edge Treatments |
N/A - Not Allowed for age 20 and above Covered for age 19 and below with Additional Copay, 80% of U&C |
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Glass Color Coatings |
N/A - Not Allowed for age 20 and above Covered for age 19 and below with Additional Copay, 80% of U&C |
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High Index |
N/A - Not Allowed for age 20 and above Covered for age 19 and below with Additional Copay if manufacturer is "Generic" or "VSP" If manufacturer is not "Generic" or "VSP" it is "Not Allowed" |
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Mirror/Ski Type Coating |
N/A - Not Allowed for age 20 and above Covered for age 19 and below with Additional Copay, 80% of U&C |
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Near Variable Focus |
Covered with Additional Copay if manufacturer is "Generic" or "VSP" If manufacturer is not "Generic" or "VSP" it is "Not Allowed" |
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Oversize Lenses |
Covered |
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Photochromics |
N/A - Not Allowed for age 20 and above Covered for age 19 and below with Additional Copay |
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Plastic Dyes (Gradient) |
N/A - Not Allowed for age 20 and above Covered for age 19 and below with Additional Copay |
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Plastic Dyes (Solid color except Pink I & II) |
N/A - Not Allowed for age 20 and above Covered for age 19 and below with Additional Copay |
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Polarized |
N/A - Not Allowed for age 20 and above Covered for age 19 and below with Additional Copay if manufacturer is "Generic" or "VSP" If manufacturer is not "Generic" or "VSP" it is "Not Allowed" |
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Polycarbonate |
Covered for age 19 and below if manufacturer is "Generic" or "VSP" If manufacturer is not "Generic" or "VSP" it is "Not Allowed" Covered for 20 and above, only for monocular prescription if manufacturer is "Generic" or "VSP". If manufacturer is not "Generic" or "VSP" it is "Not Allowed". (Call 800.615.1883 to obtain authorization for Polycarbonate lenses for monocular prescriptions) |
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Progressives |
N/A - Not Allowed for age 20 and above Covered for age 19 and below with Additional Copay if manufacturer is "Generic" or "VSP" If manufacturer is not "Generic" or "VSP" it is "Not Allowed" |
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Rimless Drill |
N/A - Not Allowed for age 20 and above Covered for age 19 and below |
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Scratch Resistant Coatings |
N/A - Not Allowed for age 20 and above Covered for age 19 and below with Additional Copay if manufacturer is "Generic" or "VSP" If manufacturer is not "Generic" or "VSP" it is "Not Allowed" |
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Solid Tints and Plastic Dyes (Pink I & II) |
Covered |
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UV Protection |
N/A - Not Allowed for age 20 and above Covered for age 19 and below |
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*Coverage applies to Polycarbonate only, see the lens enhancement charges tab to view patient charges. This information does not guarantee patient eligibility, patient coverage, or payment to providers. Confirmation of eligibility will be determined upon receipt of the claim by VSP. |
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Disaster Relief gift certificates are distributed through the American Red Cross and VSP Eyes of Hope mobile clinics to adults and children who need eye care or have lost or damaged their glasses during a disaster. |
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ELIGIBILITY |
To use this gift certificate, the patient must: need eye care due to a disaster or have lost or damaged eyewear during a disaster; not have used another gift certificate in the last 12 months. VSP members are NOT eligible for Disaster Relief gift certificates, as VSP will reinstate benefits for members who need eye care or replacement glasses as a result of a disaster. Patients covered by the VSP Access Plan may qualify for Disaster Relief gift certificates if they meet all eligibility criteria. Call VSP to clarify the member’s VSP coverage or reinstate benefits. |
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Exam/ProfSvcs |
Covered - Every 12 months |
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Lens |
Covered - Every 12 months if manufacturer is "Generic" or "VSP" If manufacturer is not "Generic" or "VSP" it is "Not Allowed" |
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Frame |
Covered - Every 12 months |
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Benefit |
VSP Choice Plan® |
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Network |
Choice |
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Lab Use |
Must be processed through an approved VSPOne® Technology Center (Lab) from the eClaim drop-down menu. Please follow all other standard lab processing procedures; reserve private lab use for emergencies. |
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Low Vision |
Criteria applies. Please see Low Vision in the Plans & Coverages section for further information. |
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Vision Therapy |
Not Covered |
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Coordination of Benefits |
COB rule 9: COB isn't allowed. Call VSP at 800.615.1883 for client exceptions and specific instructions. |
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Retinal Screening |
Charge the lesser of $39 or U&C |
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PLAN DETAILS |
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Co-Payments |
Lens $0, Frame $0 |
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Frame Allowance |
Frames are covered up to $150.00 (wholesale $57) for Marchon® and Altair® Eyewear brands frames. If the frame exceeds wholesale and retail allowance, the patient pays the retail overage. If the frame exceeds wholesale and retail allowance, the patient pays the retail overage after a 20% discount. If patient chooses a new non-Marchon or non-Altair frame, the frame is not covered by VSP under this program and patient is responsible for the cost of the frame. If you need to add Marchon and Altair frames to your dispensary that are covered by the program, please contact your Sales Representative or Customer Service: Marchon (800) 645-1300/Altair (800) 505-5557. The collections can be viewed at marchon.com and altaireyewear.com. |
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Necessary Contact Lenses (NCL) |
Criteria applies. Please see Necessary Contact Lenses in the Plans & Coverages section for further information. Copay $0. |
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Value Added Benefits |
20% off a complete additional pair of glasses, including plano sunglasses, from a VSP doctor within 12 months of routine exam. 15% off contact lens exam services from a VSP doctor for 12 months on or following date of routine exam. |
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LENS ENHANCEMENT DETAILS |
Polycarbonate lenses are covered for patients 19 years old or younger, and for adults (ages 20 and above) with monocular vision (Call 800.615.1883 to obtain authorization for Polycarbonate lenses for monocular prescriptions). Adult patients without monocular prescriptions can opt to pay for polycarbonate lenses. Please see Lenses on Materials Coverage section for more information. Disaster Response Gift Certificates now allow patients the option to cover the cost of certain lens enhancements labeled “Patient Pay.” However, the gift certificate program is intended to help patients affordably replace essential eyewear lost/damaged due to a disaster. Please do not actively upsell patients who may not be able to afford the cost of enhancements. Lens enhancements listed as “N” or “Non-covered” are not available to the patient and will invalidate the materials portion of the claim. If a claim is submitted with non-covered lens enhancements, the provider will be responsible for the lab bill and for the entire cost of all materials. |
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Anti-reflective Coatings |
Patient Pays |
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Aspheric (plastic & digital) |
Covered with Additional Copay if manufacturer is "VSP" If manufacturer is not "VSP" it is "Not Allowed" |
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Blended Bifocal |
Patient Pays |
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Edge Treatments |
Patient Pays |
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Glass Color Coatings |
Patient Pays |
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High Index |
Patient Pays |
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Mirror/Ski Type Coating |
Patient Pays |
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Near Variable Focus |
Covered with Additional Copay if manufacturer is "VSP" If manufacturer is not "VSP" it is "Not Allowed" |
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Oversize Lenses |
Covered |
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Photochromics |
Patient Pays |
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Plastic Dyes (Gradient) |
Patient Pays |
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Plastic Dyes (Solid color except Pink I & II) |
Patient Pays |
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Polarized |
Patient Pays |
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Polycarbonate |
Covered for age 19 and below if manufacturer is "Generic" or "VSP" If manufacturer is not "Generic" or "VSP" it is "Not Allowed" Covered for 20 and above, only for monocular prescription if manufacturer is "Generic" or "VSP". If manufacturer is not "Generic" or "VSP" it is "Not Allowed". (Call 800.615.1883 to obtain authorization for Polycarbonate lenses for monocular prescriptions) For age 20 and above, without monocular prescription: Patient Pays |
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Progressives |
Patient Pays |
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Rimless Drill |
Patient Pays |
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Scratch Resistant Coatings |
Patient Pays |
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Solid Tints and Plastic Dyes (Pink I & II) |
Covered |
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UV Protection |
Patient Pays |
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Plano |
N/A – Not Allowed |
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*Coverage applies to Polycarbonate only, see the lens enhancement charges tab to view patient charges. This information does not guarantee patient eligibility, patient coverage, or payment to providers. Confirmation of eligibility will be determined upon receipt of the claim by VSP. |
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