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H1N1 Information for Faculty and Staff, Supervisors and Managers

Campus Box 8107
Pocatello, ID 83209-8107
Phone (208) 282-2517
Fax (208) 282-4976
Email: hr@isu.edu

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Human Resources

Benefits: Insurance: Vision Benefits

Declination of Dependent Vision Benefits
Filing Claims
Selecting a Provider
Summary of Vision Benefits

Summary of Vision Benefits

Vision Benefits
Vision Services Plan
1-800-877-7195 www.vsp.com

Professional Fees

  • Eye Exam, up to

 

$ 32.00

Materials—lenses per pair

  • Single vision, up to
  • Bifocal, up to
  • Trifocal, up to
  • Lenticular, up to
  • Frame, up to

 

$ 32.00
$ 60.00
$ 72.00
$100.00
$ 30.00

Contact Lenses—per pair (evaluation, materials and fittings only)

  • Elective, up to
  • Medically Necessary, up to

 

$ 47.00
$100.00

Service Frequency Limitations
  • Insured may receive one eye exam every twelve months
  • Insured may receive one pair of spectacle lenses or contact lenses every twelve months
  • Insured may receive one frame every twenty-four months

VSP Provider Benefit:
20% discount on complete pair of prescription glasses and/or 15% discount on doctor’s professional services (exams associated with contact lenses) if your doctor is a VSP provider.  Your VSP provider will submit billing for you.

Declination of Dependent Vision Benefits

Dependent vision coverage is available only if the dependents are also covered by the State medical plan. You may decline vision coverage for your family. To decline vision coverage for your family, employees must indicate that they are enrolling as "self-only" on the State's medical plan enrollment form. The effective date is the first of the month following the declination. After declining, you may only add your family to vision coverage when there is an open enrollment for vision. There may be several years between open enrollment periods for vision.

Selecting a Provider

You can use any provider you want; however, VSP providers offer discounts and will submit billing to VSP on your behalf. To find Participating Vision Providers, please contact Vision Service Plan, 1-800-877-7195 or go on-line http://www.vsp.com Go to “Members & Consumers”, then select “Find a VSP Network Doctor.”In order to log into the VSP web site, you will need to enter your 9 digit member identification which is also your Blue Cross Enrollee Identification number, found on your Blue Cross ID card.

Filing Claims

Participating providers will bill the plan on your behalf. When you use a non-participating provider, you will have to file a claim for reimbursement with VSP. Completed forms with related receipts can be faxed to (916) 851-5152 or mailed to:

VSP
PO Box 997105
Sacramento, CA 95899-7105