Exam Plus Savings Plan is a new Choice product that offers patients a covered exam, less any copay, and a competitive national lens fee schedule, special pricing on lens enhancements, and savings* on frames and contact lens exams.

Obtain eligibility on eyefinity.com or by calling VSP at 800.615.1883.

Exam Plus Savings Plan is listed on the VSP Patient Record Report under Benefit.

Covered comprehensive eye exams are generally available to your patient once every 12 or 24 months on a service year, fiscal year, or calendar year basis. Provide the level of exam necessary to determine your patient’s eye health and visual status.

• Eye exam fees are made according to your Choice Network Fee Schedule, less applicable copay.
• Deduct 20% on additional eye exams, including if only a refraction is performed.
• Is unlimited for 12 months on or following the date of the last eye exam.
• Retinal screening: patients pay $39 or your U&C fee, whichever is lower.

Use the following to charge eligible patients for frames, lenses, and lens enhancements when a complete pair of prescription glasses is dispensed.

• Eligible patients can receive unlimited complete sets of prescription glasses from any VSP doctor.
• Is unlimited for 12 months on or following the date of the last covered eye exam.
• Patient is not required to receive exam from your office to receive material savings
• Use professional judgment when evaluating prescriptions from another doctor. If necessary, you can request an additional routine exam at 80% of U&C.

Frame: patients pay 75% of the retail price of the frame.

Lens enhancements: use the Choice Plan Lens Enhancements Chart to determine patient pricing for lens enhancements.

Be aware of the following materials requirements:

• Must provide complete pairs of glasses with both lenses and frame
• Only complete sets of lenses (includes balance lenses)
• Proprietary lens and frame are not allowed
• Frame must be doctor-supplied (not lab or patient-supplied)
• In-office finishing or the use of a non-VSP Network Lab is not allowed.
• VSP only covers frames that are used for prescription lenses that meet VSP’s minimum prescription criteria (refractive error is at least +/- 0.50 diopter).

Non-prescription glasses or sunglasses: charge 80% of U&C for complete pairs of non-prescription glasses or sunglasses and blue light filtering glasses dispensed within 12 months of the exam.

Charge eligible patients 85% of U&C for contact lens exam services (F&E) and follow-up services, and 100% of U&C for contact lens materials.

• Applies to services for prescription contact lenses only.
• Is unlimited for 12 months on or following the date of the last eye exam.
• Is available through any VSP doctor. Use professional judgment when evaluating prescriptions from another doctor.
• Discount doesn’t apply to contact lens materials, solutions, cleaning products, or service agreements.

The benefits are considered a private transaction between you and your patient; your patient is responsible for paying for the services or materials.

Orders must be sent to a VSP Network Lab. Use of a private lab or in-office finishing is not allowed and will cause the claim to deny.

Patients are eligible for the Laser VisionCare Program. Refer to the VSP Laser VisionCare Program page in the VSP Manual.

See the Laser VisionCare Program section under Programs on VSPOnline at eyefinity.com for information on how to participate or for a list of participating facilities.

Claims may be submitted on eClaim or on paper. See the Submitting Claims section in the VSP Manual for details.

Professional Services

Eye exam: you’ll be reimbursed by VSP according to your Choice Network fees.

Contact lens exam (fitting and evaluation): patient pays you directly at 85% U&C.

Retinal screening: patient pays you directly, up to $39.

Materials

Base lenses: you'll be reimbursed according to your Choice Network fees.

Lens enhancements: your service fees and chargebacks will be calculated as usual based on the VSP Choice Plan Lens Enhancement chart to cover material costs.

Contact lenses: patient pays 100% of U&C directly to you.

Non-prescription glasses or sunglasses: patient pays 80% of U&C directly to you.

Frame: Your frame compensation is calculated using the wholesale frame allowance (up to $57), plus your Choice Plan frame dispensing fee, plus 80% of the retail price over $150, which is the same as your Choice fees.

Example: Patient chooses a frame with a retail price of $200 and wholesale cost of $76.

VSP Choice compensation allowed amount:

The difference between what the patient pays and the total compensation amount is a chargeback (-$34).

The chargeback is collected from the patient’s payment to cover administrative costs of the program.

*VSP does not require providers to provide discounts on non-covered services in states where it’s prohibited by law to require it. However, unless you’ve opted out, you should continue to provide all Value Added Benefits to all VSP members. For more information, including details regarding how to opt out, call VSP at 800.615.1883.