Agmt91 Vision Service Plan VSP - Laserfiche WebLink

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"VISION SERVICE P.LAN' PROCEDURES FOR USING THE PLAN 1. To obtain vision care, a covered person should fill out and mail the postcard attached to the descriptive brochure furnished the employer. If eligible for vision care under this plan, a benefit form will be sent to the covered person along with a list of Panel Doctors in the covered person's area. CAUTION: COVERED PERSONS SHOULD NOT MAKE AN APPOINTMENT FOR VISION CARE SERVICES UNTIL THE BENEFIT FORM IS OBTAINED. 2. The covered person selects the doctor of his choice from the list of Panel Doctors accompanying the benefit form and makes an appointment for an examination. The benefit form should be presented by the covered person on the first visit. SERVICES MUST BEGIN PRIOR TO THE EXPIRATION DATE INDICATED O~ THE BENEFIT FORM. 3. When the examination has been completed, the doctor will require the signature of the covered person in the space provided on the form. The covered person pays only the deductible (if any) to the doctor for the services covered by the plan and for any additional services secured. The doctor will complete the form and mail it to VSP. VSP will pay the Panel Doctor directly according to their agreement with the doctor. NOTE: WHEN SERVICES ARE OBTAINED FROM A PROVIDER WHO IS NOT A VSP PANEL MEMBER, THE COVERED PERSON SHOULD PAY THE PROVIDER THE FULL FEE. THE COVERED PERSON WILL BE REIMBURSED IN ACCORDANCE WITH THE REIMBURSEMENT SCHEDULE AS SHOWN ON PAGE 5. THE ITEMIZED STATEMENT(S) OF CHARGES SHOULD BE SENT TO VSP ALONG WITH THE BENEFIT FORM. 4. In emergency cases, when immediate vision care is necessary, a covered person can obtain covered services by contacting a VSP Panel Doctor. The VSP Panel Doctor will call VSP for eligibility verification and VSP will mail 4he benefit form directly to the Panel Doctor. -7- 1/87 \ - .-.