Vision Services Plan will cover an eye exam, glasses or contacts every 12 months (visits must be 12 months apart); can choose member or non member providers. Eligible dependents are: spouse, domestic partner and children to age 26.
$15 Office co-pay (member providers)
How to Submit an Out-of-Network Claim:
If services are rendered by a non-member provider, VSP will reimburse up to the amount allowed under the plan’s non-VSP doctor reimbursement rate. Claims must be filed within six months after seeing the doctor.
You'll pay the provider in full for the services and eyewear received at the time of your appointment including taxes. Then you'll submit your receipt with an itemized list of services and eyewear along with the VSP Member Reimbursement Form to VSP.
- Complete the online reimbursement form from the VSP website (you must create a username & password to access the reimbursement form).
- Print the reimbursement form and send with itemized receipt(s) to: VSP, P.O. Box 997105, Sacramento, CA 95899-7105.
This summary of benefits is informational only and is not a complete description of all applicable conditions. Coverage and plan offerings are subject to change in subsequent years pursuant to District policy.