Agmt91 Vision Service Plan VSP - Laserfiche WebLink

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VISION SERVICE ~ ADD END U M ADDITIONAL BENEFIT LOW VISION I. BENEFITS Persons covered under this benefit are entitled to low vision therapy and associated materials. A. Covered persons who have a low vision condition diagnosed by a VSP Panel Doctor are entitled to professional services from the doctor as well as ophthalmic materials or other aids prescribed by the doctor subject to the limitations described in "II. PLAN LIHITATIONS" . When a VSP Panel Doctor determines the presence of a low vision condition, the doctor requests advance approval prior to beginning services. Services and materials covered can include supplemental testing evaluations, training, low vision prescription services, plus optical and non-optical aids. Non-cosmetic contact lenses for low vision patients are also covered. B. Definition of low vision - The low vision benefit is provided for people who have acuity or visual field loss. Even when provided with regular lenses there is still visual impairment. II. PLAN LIMITATIONS Following are the benefit limits under this Low Vision Care Plan. A. PRIOR AUTHORIZATION - When a Panel Doctor suspects a low vision condition, the doctor writes up the findings on a form provided by VSP and sends it to VSP for review by our Optometric consultants. If the consultants believe the patient is eligible and that the doctor is correct in his initial assessment of the problem, the consultants may authorize supplementary testing by the doctor. This benefit is paid by the Plan with no co-payment by the patient. The purpose of the testing is to determine the nature of the problem and to allow the doctor to gather enough facts to propose a treatment Plan. B. CO-PAYMENT - After supplemental testing, the doctor writes up his treatment Plan on the form provided by VSP and sends it to the VSP consultants. The consultants will review the Plan and, if the Plan is approved, will authorize benefits on a co-payment basis with 75% of the cost being paid by VSP and 25% of the cost being paid by the patient. c. MUL~IMUM BENEFIT - VSP will pay a maximum of $1,000 ( excluding co-payment) every two (2) years for approved Low Vision care. Maximum includes the Supplementary Testing. -Al- .,... 1/87LV I ""_.,-." . -.-,,-." "'_.. .-.,......-.--.--.....-. ...-..,......~.__.-.....,-<~.,