Vision Plan Coverage

Under the Vision Plan, you may receive services from any licensed ophthalmologist or optometrist; however, the plan options pay increased benefits when you receive services from a network provider.

There are no claim forms to file when you obtain services from a network provider. However, if you receive vision services from a non-network provider, you must submit to the appropriate claims administrator an itemized statement along with your bill to receive benefits.

To obtain benefits, follow these steps:

  • - Find a network provider. You can do this by calling the claims administrators or by going to their Web sites. If you already have a vision provider, check to see whether he or she participates in the network.
  • - Call a provider and make an appointment; tell the office that you are a VSP or OptumHealth Vision member, as appropriate. The provider will call VSP or OptumHealth Vision to verify your (or your dependent’s) eligibility and plan coverage. If you are not eligible-for example, if you have already had an exam within the allotted time frame-the provider’s office will explain to you why and discuss your options.

Then, if you receive services from a:

  • - Network provider-simply pay the applicable copay at the time of your visit. Your provider and the claims administrator will handle the rest. (For information about any additional charges you may be required to pay, see “What the Vision Plan Does Not Cover” in the following section.)
  • - Non-network provider-you must pay the bill in full at the time you receive the services. Then, submit an itemized statement to the appropriate claims administrator. The claims administrator will then reimburse you according to the schedule of allowances for non-network providers as outlined previously. Be sure to submit this information to the claims administrator within six months (12 months for OptumHealth Vision) of your visit.

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Questions about your employee benefits or other Human Resources issues? Contact the Workplace Solutions Center at (888) 471-2271.