You can select from several nationwide, and in some areas, regional dental Preferred Provider Organization (PPO) or Health Maintenance Organization (HMO) plans, and high and standard coverage options.  You can also select from several nationwide vision plans.  You may enroll in a dental plan or a vision plan, or both.  Some TRICARE beneficiaries may not be eligible to enroll in both.  Visit www.opm.gov/dental or
www.opm.gov/vision for more information.

You enroll online at www.BENEFEDS.gov.  Please see Section 2, Enrollment, for more information.

If you sign up for a dental and/or vision plan during the 2024 Open Season, your coverage will begin on January 1, 2025.  Premium deductions will start with the first full pay period beginning on/after January 1, 2025.  You may use your benefits as soon as your eligibility is confirmed.

Each year, an open season will be held during which you may enroll or change your vision/dental plan enrollment.  This year, open season runs from November 11, 2024 through December 9, 2024 (midnight EST). You do not need to re-enroll each open season, unless you wish to change plans or plan options; your coverage will continue from the previous year.  In addition to the annual open season, there are certain events that allow you to make specific types of enrollment changes throughout the year. Please see Section 2, Enrollment, for more information.

Employees automatically pay premiums through payroll deductions using pre-tax dollars.  Annuitants automatically pay premiums through annuity deductions using post-tax dollars. TRICARE enrollees automatically pay premiums through payroll deduction or automatic bank withdrawal (ABW) using post-tax dollars.

If you are a Federal or U.S. Postal Service employee, you are eligible to enroll in FEDVIP, if you are eligible for the Federal Employees Health Benefits (FEHB) Program, the Postal Service Health Benefits (PSHB) Program, or the Health Insurance Marketplace (Exchange) and your position is not excluded by law or regulation.  Enrollment in the FEHB Program, PSHB Program, or the Health Insurance Marketplace (Exchange) is not required.

Certain temporary, intermittent, and seasonal Federal and U.S. Postal Service employees are now eligible to enroll in FEDVIP. To be eligible, these employees must be expected to work 130 hours per calendar month for at least 90 days. In addition, certain firefighters hired under a temporary appointment and intermittent emergency response personnel are eligible to enroll in FEDVIP. The employing agency must determine and notify these employees of their eligibility.   

You are eligible to enroll if you:

• Retired on an immediate annuity under the Civil Service Retirement System (CSRS), the Federal Employees Retirement System (FERS) or another retirement system for employees of the Federal Government;
• Retired for disability under CSRS, FERS, or another retirement system for employees of the Federal Government.

Your FEDVIP enrollment will continue into retirement if you retire on an immediate annuity or for disability under CSRS, FERS or another retirement system for employees of the Government, regardless of the length of time you had FEDVIP coverage as an employee.  There is no requirement to have coverage for 5 years of service prior to retirement to continue coverage into retirement, as there is with the FEHB/PSHB Program.

Your FEDVIP coverage will end, if you retire on a Minimum Retirement Age (MRA) + 10 retirement and postpone receipt of your annuity.  You may enroll in FEDVIP again when you begin to receive your annuity.

An individual who is eligible for FEDVIP dental coverage based on the individual's eligibility to previously be covered under the TRICARE Retiree Dental Program or an individual eligible for FEDVIP vision coverage based on the individual's enrollment in a specified TRICARE health plan.

Retired members of the uniformed services and National Guard/Reserve components, including “gray-area” retirees under age 60 and their families are eligible for FEDVIP dental coverage.  These individuals, if enrolled in a TRICARE health plan, are also eligible for FEDVIP vision coverage.  In addition, uniformed services active duty family members who are enrolled in a TRICARE health plan are eligible for FEDVIP vision coverage.

Except with respect to TRICARE-eligible individuals, family members include your spouse and unmarried dependent children under age 22.  This includes legally adopted children and recognized natural children who meet certain dependency requirements.  This also includes stepchildren and foster children who live with you in a regular parent-child relationship.  Under certain circumstances, you may also continue coverage for a disabled child 22 years of age or older who is incapable of self-support.  FEDVIP rules and FEHB/PSHB rules for family member eligibility are NOT the same.  For more information on family member eligibility visit the website at www.BENEFEDS.gov or contact your employing agency or retirement system.

With respect to TRICARE-eligible individuals, family members include your spouse, unremarried widow, unremarried widower, unmarried child, and certain unmarried persons placed in your legal custody by a court. An unremarried former spouse who meets the U.S. Department of Defense’s 20-20-20 and/or 20-20-15 benefit eligibility requirements may only enroll in a self-only FEDVIP vision plan. Children include legally adopted children, stepchildren, and pre-adoptive children.  Children and dependent unmarried persons must be under age 21 if they are not a student, under age 23 if they are a full-time student, or incapable of self-support because of a mental or physical incapacity. 

The following persons are not eligible to enroll in FEDVIP, regardless of FEHB/PSHB eligibility or receipt of an annuity or portion of an annuity:

• Deferred annuitants
• Former spouses of employees or annuitants.  Note:  Former spouses of TRICARE-eligible individuals may enroll in a FEDVIP vision plan.
• FEHB/PSHB Temporary Continuation of Coverage (TCC) enrollees
• Anyone receiving an insurable interest annuity who is not also an eligible family member
• Active duty uniformed service members.  Note:  If you are an active duty uniformed service member, your dental and vision coverage will be provided by TRICARE.  Your family members will still be eligible to enroll in the TRICARE Dental Plan (TDP).
• Temporary/seasonal employees who do not meet the 130 hours per calendar month for 90 days.

You must use BENEFEDS to enroll or change enrollment in a FEDVIP plan.  BENEFEDS is a secure enrollment website (www.BENEFEDS.gov) sponsored by OPM.  If you do not have access to a computer, call 1.877.888.FEDS (1.877.888.3337), TTY number 1.877.889.5680 to enroll or change your enrollment.

If you are currently enrolled in FEDVIP and do not want to change plans or options, your enrollment will continue automatically.  Please Note: your plans' premiums may change for 2025.

Note: You cannot enroll or change enrollment in a FEDVIP plan using the Health Benefits Election Form (SF 2809) or through an agency self-service system, such as Employee Express, PostalEase, EBIS, MyPay, or Employee Personal Page.  However, those sites may provide a link to BENEFEDS.

Self Only: A Self Only enrollment covers only you as the enrolled employee or annuitant. You may choose a Self Only enrollment even though you have a family.  However, your family members will not be covered under FEDVIP.

Self Plus One: A Self Plus One enrollment covers you as the enrolled employee or annuitant plus one eligible family member whom you specify.  You may choose a Self Plus One enrollment even though you have additional eligible family members, but the additional family members will not be covered under FEDVIP. 

Self and Family: A Self and Family enrollment covers you as the enrolled employee or annuitant and all of your eligible family members.  You must list all eligible family members when enrolling.

If you or one of your family members is enrolled in or covered by one FEDVIP plan, that person cannot be enrolled in or covered as a family member by another FEDVIP plan offering the same type of coverage (i.e., you or covered family members cannot be covered by two FEDVIP dental plans or two FEDVIP vision plans).

Open Season

If you are an eligible employee, annuitant, or TRICARE-eligible individual (TEI), you may enroll in a dental and/or vision plan during open season, November 11, 2024 through December 9, 2024 (midnight EST). Coverage is effective January 1, 2025.

During future annual open seasons, you may enroll in a plan, or change or cancel your dental and/or vision coverage.  The effective date of these open season enrollments and changes will be set by OPM.  If you want to continue your current enrollment, do nothing.  Your enrollment carries over from year to year, unless you change it.

New hire/Newly eligible

You may enroll within 60 days after you become eligible as:

• a new employee;
• a previously ineligible employee who transferred to a covered position;
• a survivor annuitant if not already covered under FEDVIP; or
• an employee returning to service following a break in service of at least 31 days.
• a TRICARE-eligible individual

Your enrollment will be effective on the first day of the pay period following the one in which BENEFEDS receives and confirms your enrollment.

Qualifying Life Event

A qualifying life event (QLE) is an event that allows you to enroll, or if you are already enrolled, allows you to change your enrollment outside of an open season.   

The following chart lists the QLEs and the enrollment actions you may take:

Qualifying Life Event: Marriage
From Not Enrolled to Enrolled: Yes
Increase Enrollment Type: Yes
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: Yes

Qualifying Life Event: Acquiring an eligible family member (non-spouse)
From Not Enrolled to Enrolled: No
Increase Enrollment Type: Yes
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: No

Qualifying Life Event: Losing a covered family member
From Not Enrolled to Enrolled: No
Increase Enrollment Type: No
Decrease Enrollment Type: Yes
Cancel: No
Change from One Plan to Another: No

Qualifying Life Event: Losing other dental/vision coverage (eligible or covered person)
From Not Enrolled to Enrolled: Yes
Increase Enrollment Type: Yes
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: No

Qualifying Life Event: Moving out of regional plan's service area
From Not Enrolled to Enrolled: No
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: Yes

Qualifying Life Event: Going on active military duty, non- pay status (enrollee or spouse)
From Not Enrolled to Enrolled: No
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: Yes
Change from One Plan to Another: No

Qualifying Life Event: Returning to pay status from active military duty (enrollee or spouse)
From Not Enrolled to Enrolled: Yes
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: No

Qualifying Life Event: Returning to pay status from Leave without pay
From Not Enrolled to Enrolled: Yes (if enrollment cancelled during LWOP)
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: Yes (if enrollment cancelled during LWOP)

Qualifying Life Event: Annuity/ compensation restored
From Not Enrolled to Enrolled: Yes
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: No
Change from One Plan to Another: No

Qualifying Life Event: Transferring to an eligible position*
From Not Enrolled to Enrolled: No
Increase Enrollment Type: No
Decrease Enrollment Type: No
Cancel: Yes
Change from One Plan to Another: No

*Position must be in a Federal agency that provides dental and/or vision coverage with 50 percent or more employer-paid premium.

The timeframe for requesting a QLE change is from 31 days before to 60 days after the event. There are two exceptions:

• There is no time limit for a change based on moving from a regional plan’s service area; and
• You cannot request a new enrollment based on a QLE before the QLE occurs, except for enrollment because of a loss of dental or vision insurance. You must make the change no later than 60 days after the event.

Enrollments and enrollment changes made based on a QLE are effective on the first day of the pay period following the one in which BENEFEDS receives and confirms the enrollment or change. BENEFEDS will send you confirmation of your new coverage effective date.

Once you enroll in a plan, your 60-day window for that type of plan ends, even if 60 calendar days haven’t yet elapsed. That means once you have enrolled in either a dental or a vision plan, you cannot change or cancel that particular enrollment until the next open season, unless you experience a QLE that allows such a change or cancellation.

VA Exception for Cancellation

Generally, you may cancel your enrollment only during the annual open season. However, if you are a FEDVIP enrollee paying premiums on a post-tax basis, and you, your family member, or TEI family member becomes eligible for VA dental or vision benefits, then you may change your enrollment type or cancel your enrollment within 60 days of receiving notification of VA dental or vision eligibility. This 60-day period may fall outside of open season. VA dental or vision eligibility documentation must be submitted to OPM via the BENEFEDS mailbox (benefedsportal@opm.gov) within 60 days of notification to support the FEDVIP enrollment change or cancellation. 

Your cancellation is effective at the end of the day before the date OPM sets as the open season effective date. An eligible family member’s coverage also ends upon the effective date of the cancellation. 

If you are a FEDVIP enrollee paying premiums on a pre-tax basis, and you, your family member, or TEI family member becomes eligible for VA dental or vision benefits, then you may not change or cancel your FEDVIP enrollment until the next open season. 

FEDVIP enrollees can verify if they are paying their premiums on a pre- or post- tax basis by contacting BENEFEDS at 877.888.3337, TTY number 877.889.5680. 

Coverage ends for active and retired Federal, U.S. Postal employees, and TRICARE-eligible individuals when you:

• no longer meet the definition of an eligible employee, annuitant, or TRICARE-eligible individual;
• as a Retired Reservist you begin active duty;
• as sponsor or primary enrollee leaves active duty;
• begin a period of non-pay status or pay that is insufficient to have your FEDVIP premiums withheld, and you do not make direct premium payments to BENEFEDS;
• are making direct premium payments to BENEFEDS and you stop making the payments;
• cancel the enrollment during open season;
• a Retired Reservist begins active duty; or
• the sponsor or primary enrollee leaves active duty.

Coverage for a family member ends when:

• you as the enrollee lose coverage; or
• the family member no longer meets the definition of an eligible family member.

Under FEDVIP, there is no 31-day extension of coverage. The following are also NOT available under the FEDVIP plans:

• Temporary Continuation of Coverage (TCC);
• spouse equity coverage; or
• right to convert to an individual policy (conversion policy).

If you are planning to enroll in an FSAFEDS Health Care Flexible Spending Account (HCFSA) or Limited Expense Health Care Flexible Spending Account (LEX HCFSA), you should consider how coverage under a FEDVIP plan will affect your annual expenses, and thus the amount that you should allot to an FSAFEDS account. Please note that insurance premiums are not eligible expenses for either type of FSA.   

Please review IRS - Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans (www.irs.gov/forms-pubs/about-publication-969) for additional information about carryover and contribution amounts for the upcoming tax year. If you have an HCFSA or LEX HCFSA FSAFEDS account and you have not exhausted your funds by December 31st of the plan year, FSAFEDS can automatically carry over a set maximum amount of unspent funds into another health care or limited expense account for the subsequent year. To be eligible for carryover, you must be employed by an agency that participates in FSAFEDS and actively making allotments from your pay through December 31st. You must also actively re-enroll in a health care or limited expense account during the next open season to be carryover eligible. Your re-enrollment must meet the minimum contribution amount for the plan year. If you do not re-enroll, or if you are not employed by an agency that participates in FSAFEDS and actively making allotments from your pay through December 31st, your funds will not be carried over. 

Because of the tax benefits an FSA provides, the IRS requires that you forfeit any money for which you did not incur an eligible expense and file a claim in the time permitted. This is known as the “Use-it-or-Lose-it” rule. Carefully consider the amount you will elect. 

Current FSAFEDS participants must re-enroll to participate in the program next year.

See www.fsafeds.gov or call 1-877-FSAFEDS (372-3337) or TTY: 1-866-353-8058. Note: FSAFEDS is not open to retired employees or to TRICARE eligible individuals. 

If you enroll or are enrolled in a high deductible health plan with a health savings account (HSA) or health reimbursement arrangement (HRA), you may use your HSA or HRA to pay for qualified dental/vision costs not covered by your FEHB/PSHB and/or FEDVIP plans. 

Once enrolled, ID cards are not necessary to obtain services.  Your eye care provider will verify your eligibility and benefits with VSP directly.

For members who prefer ID cards, create an account at www.vsp.com, and log in to print a personalized Member ID Card.

You can get covered care from any VSP network doctor or out-of-network provider.  However, you will get the most out of your benefit when you see a VSP in-network doctor (plan provider), and you'll only be responsible for your copayments at the time of your visit.

VSP lists plan providers in the provider directory. The list is available at  
www.choosevsp.com/find-a-doctor or you may call 800.807.0764 or TTY 711.

Make an appointment with a VSP network doctor and tell them you are a VSP member. Your doctor will confirm your eligibility with VSP.  Your copayment, out-of-pocket expenses for overages, and expenses for non-covered options are due at the time of the visit.

You may obtain care from any licensed eye care provider. If the provider you use is not part of the VSP doctor network, benefits will be considered out-of-network. VSP will partially reimburse services performed by out-of-network providers. Refer to the Summary of Benefits section. You must pay the bill at the time of service and submit the claim to VSP for partial reimbursement. Sign in to your account on www.vsp.com, click on "View Your Benefits," then “My Benefits.” Scroll to the bottom to access the Out-of-Network Claim Form, and then follow the instructions and upload your receipt(s). If you do not have Internet access, you may call 800.807.0764 or TTY 711 and request a claim form to return with an itemized receipt listing the services received. Please keep a copy of the information and mail the originals to:

VSP Vision Care
Attn: Claims Services
P.O. Box 495918
Cincinnati, OH 45249-5918

When services are rendered by a provider who participates with both your FEHB/PSHB and your FEDVIP plan, the FEHB/PSHB plan will pay benefits first. The FEDVIP plan allowance will be the prevailing charge, in these cases. You are responsible for the difference between the FEHB/PSHB and FEDVIP benefits payments and the FEDVIP plan allowance. VSP will facilitate the process with the primary FEHB/PSHB first payor.

IF: You have vision coverage through a non-FEHB/non-PSHB plan and VSP coverage under FEDVIP (covered through a spouse)
THEN: VSP is the primary payor and your non-FEHB/non-PSHB plan is secondary.

IF: If your covered dependent child has coverage through a non-FEHB/non-PSHB plan and VSP coverage under FEDVIP
THEN: The parent's plan whose birthday occurs first in the calendar year (1. Month, 2. Date) is primary. If the months and dates are the same for both parents, the primary payor is the plan that has provided coverage the longest.

If you live in an area that does not have adequate access to a VSP network doctor and you receive covered services from an out-of-network provider, VSP will reimburse you up to the plan allowance.  You are responsible for any difference between the amount billed and VSP's payment. Follow out-of-network claim submission instructions.

A copay is a fixed amount of money you pay to the provider when you receive services.

Example: In the VSP High Option plan, you pay a $10 copay for an exam and/or prescription glasses/necessary contact lenses.

You maximize your benefits when you visit a VSP in-network doctor. Your eye exam and prescription glasses or contacts are covered up to your plan allowances after any copays. You will also receive 20% savings on any out-of-pocket costs over your frame allowance and an average of 30% savings on other lens enhancements. (Based on applicable laws. Benefits may vary by doctor locations. Coverage with a retail chain may be different or not apply. See your doctor for pricing.)

• High Option:
  • $10 total copay for eye exam and/or prescription glasses/necessary contact lenses
  • TechShield^® anti-glare lens coatings and light-reactive lenses, like SunSync^®, are included as lens upgrades.
• Standard Option: $10 copay for eye exam and $20 copay for prescription glasses/necessary contact lenses 
• Both plans: $0 copay for eye exam at VSP Premier Edge™ locations

You’ll get more out of your coverage and pay lower out-of-pocket costs when you see a VSP network doctor. Plus, there are no claim forms to submit when you see an in-network doctor. When you visit an out-of-network provider, you will be reimbursed according to the following schedule:

Eye Exam: up to $45
Lens: Single Vision: Up to $45
Lens: Lined bifocal: Up to $65
Lens: Lined trifocal: Up to $85
Lens: Lenticular: Up to $125
Frames: Up to $47
Contact Lenses: Elective: Up to $105
Contact Lenses: Necessary: Up to $210

Eye examination - fully covered (once every calendar year).

VSP doctors provide a WellVision Exam, a comprehensive exam that focuses on your eyes and overall wellness.

$10

$0 at Premier Edge locations

$10

$0 at Premier Edge locations

A total copay, covering both the eye exam and prescription glasses/necessary contact lenses, or a single service, like an exam-only or glasses/necessary contact lenses-only.

You may choose prescription glasses or contacts.

Lenses - fully covered (once every calendar year)

Glass or plastic single vision, lined bifocal, lined trifocal, lenticular lenses.

$20

$10

$0 at Premier Edge locations

A total copay, covering both the eye exam and prescription glasses/necessary contact lenses, or a single service, like an exam-only or glasses/necessary contact lenses-only.

Lens Enhancements

Impact-resistant lenses (polycarbonate lenses)

Tints

$0

$15-$17

$0

$0 

Scratch-resistant coating

$0

$0

Anti-reflective coating (anti-glare)

Standard Anti-reflective: $41

Premium Anti-reflective: $68

Custom Anti-reflective: $85

TechShield^® AR Coatings: $0

Standard Anti-reflective: $21

Premium Anti-reflective: $48

Custom Anti-reflective: $65

$0

$0

Light-reactive lenses, such as SunSync (Light indoors, dark outdoors)

$75

$0 

$0

$0

$95 - $105

$95 - $105

$150 - $175

$150 - $175

Frames - covered (once every calendar year)

$200 Featured Frame Brand allowance at most in-network locations OR any frame brand at Visionworks

OR

$150 Standard frame allowance at in-network locations (including Walmart/Sam's Club)

20% savings on amount over the allowance and on additional eyewear

$250 Featured Frame Brand allowance at most in-network locations OR any frame brand at Visionworks

OR 

$200 Standard frame allowance at in-network locations (including Walmart/Sam's Club)

20% savings on amount over the allowance and on additional eyewear

Contact Lenses instead of glasses - Elective

(once every calendar year instead of glasses)

$120 allowance

Contact lens exam (fitting and evaluation) up to $55 copay

$150 allowance

Contact lens exam (fitting and evaluation) up to $55 copay

Contact Lenses instead of glasses - Necessary

(once every calendar year instead of glasses)

$20 copay

$10 copay

$0 at Premier Edge Locations

• Dependents under 18 have two fully covered WellVision Exams annually, if needed.
• An additional set of lenses or contacts is covered in the same plan year, if needed. (Minimum prescription change is required, and any plan copays for exam and/or materials apply towards additional services.)

Visit a VSP network doctor and choose either prescription eyewear coverage or use your VSP LightCare^TM benefit toward ready-made:

• Non-prescription sunglasses or
• Non-prescription blue light filtering glasses

• Covered-in-full retinal screening (digital imaging of the inside of the eye) for members with diabetes who do not have diabetic eye disease.
• Additional exams and services that track and monitor diabetic eye disease progression.
• Treatment for dry eye, pink eye, eye injury, and foreign body removal.
• Exams and services to diagnose and monitor glaucoma and cataracts.
• Tests to diagnose sudden vision changes.
• Coordination with your medical coverage may apply. Ask your VSP network doctor for details.

This benefit is available for patients having vision loss sufficient enough to prevent reading, moving around in unfamiliar surroundings and completing desired tasks. Patients with low vision have visual impairments not fully treatable by medical, surgical or conventional eyewear or contact lenses.  Low vision benefits must be pre-authorized.

Your low vision coverage from a VSP network doctor provides:

• Low vision exams and low vision aids, up to a $1,000 maximum, every two years.
• Low vision supplemental testing, if approved, will be covered in full every two years. If low vision aids are approved, VSP will pay 75% of the approved amount up to a maximum of $1,000 (less any amount paid for supplemental testing) per covered individual every two years. The patient is responsible for the remaining 25% of the approved amount plus any amount over the maximum.

If you choose to go out-of-network, you must pay the provider at the time of your appointment and submit the claims for partial reimbursement. There is no guarantee of reimbursement. If your claim is approved, you will be reimbursed up to the amount we pay a VSP network doctor.  For example, if you are charged $200 for the supplemental evaluation, your reimbursement amount would not exceed VSP’s maximum payable of $125.

The following additional savings are only available from VSP network doctors.

Prescription glasses

• Average 30% savings on all other lens options.
• 20% savings on additional prescription and non-prescription glasses and sunglasses from any VSP network doctor within 12 months of your last covered exam.
• 20% savings on amount over the frame allowance and on additional eyewear.

Contacts

• 15% savings on the cost of contact lens exam from any VSP network doctor within 12 months of your last covered exam.

Laser Vision Correction

• Average 15% off the regular price; discounts available at contracted facilities.

Retinal Screening

• Members with diabetes who do not have diabetic eye disease get a fully covered retinal screening through the new Essential Medical Eye Care coverage. No more than a $39 copay on routine retinal screening as an enhancement to your WellVision Exam for members without diabetes.

 **Based on applicable laws. Benefits may vary by doctor location. See your doctor for pricing.

Coverage with a retail chain may be different or not apply. 

VSP guarantees member satisfaction from VSP providers only. Frames and lenses purchased at Premier Edge locations or through Premier Edge providers include an added benefit of the Premier Edge Promise, a worry-free eyewear guarantee. This guarantee replaces broken or damaged frames, prescription lens changes, and replacement of equal or lesser value of Featured Frame Brand purchases if not satisfied with your look. VSP Premier Edge is not available for some members in the state of Texas.

Some restrictions may apply--learn more here: www.choosevsp.com/why-enroll.

In the event of a conflict between this information and your organization's contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location. In the state of Washington, VSP Vision Care, Inc., is the legal name of the corporation through which VSP does business. 

Some brands of spectacle frames and lenses may be unavailable for purchase as Plan Benefits, or may be subject to additional limitations. Covered Persons may obtain details regarding frame and lens brand availability from their VSP Network Doctor or by calling VSP Member Services at 800.807.0764.

Necessary Contact Lenses are a Plan Benefit when specific benefit criteria are satisfied and when prescribed by Covered Person's VSP Network Doctor or Out of Network Provider. Review and approval by VSP are not required for Covered Person to be eligible for Necessary Contact Lenses.

*Please refer to Section 4, Your Cost for Covered Services, for the nationwide reimbursement schedule and Section 6, International Services and Supplies, for the international reimbursement schedule.

VSP is a nationwide vision plan and therefore does not have network doctors overseas.  To obtain services, visit any international eyecare provider and you will be reimbursed 75% of billed charges up to this international out-of-network schedule:

Eye Exam: up to $65
Lens: Single Vision: Up to $55
Lens: Lined bifocal: Up to $75
Lens: Lined trifocal: Up to $95
Lens: Lenticular: Up to $125
Frames: Up to $120
Contact Lenses: Elective: Up to $105
Contact Lenses: Necessary: Up to $210

Visit the international eye care provider of your choice.  You will need to submit a claim for reimbursement.

 

Sign in to your account on www.vsp.com, click on "View Your Benefits" then "My Benefits." Scroll to the bottom to access the Out-of-Network Claim Form, and then follow the instructions to upload your receipt.  If you do not have Internet access, send an itemized receipt listing the services received along with the patient's name and covered member's name and ID number to VSP.  Please keep a copy of the information and mail the originals to:

VSP Vision Care
Attn: Claims Services
P.O. Box 495918
Cincinnati, OH 45249-5918

Review VSP plan information on www.choosevsp.com.

Create an account at www.vsp.com to view your personalized benefits dashboard and check out your savings statement.

Call VSP Member Services at 800.807.0764 or TTY 711.

Please refer to the Rate Information section to view rates. Premiums for international members are the same as nationwide members.

When you visit a VSP network doctor, you do not complete any paperwork or claim forms.  VSP network doctors verify your eligibility, plan coverage, and obtain authorization from VSP.

If you decide not to see a VSP network doctor, call 800.807.0764 or TTY 711. You are required to pay the provider in full at the time of your appointment and submit a claim for reimbursement.

Sign on to www.vsp.com and access the Out-of-Network Reimbursement Form and follow the instructions.  If you do not have Internet access, you may call 800.807.0764 or TTY 711 and request a claim form to return with an itemized receipt listing the services received.  Please keep a copy of the information and mail the originals to:

VSP Vision Care
Attn: Claims Services
P.O. Box 495918
Cincinnati, OH 45249-5918

Follow this disputed claims process if you disagree with our decision on your claim or request for services.  The FEDVIP law does not provide a role for OPM to review disputed claims.

Disputed Claim Steps:

1. In order to reconsider our initial decision.  You must:

• Contact VSP Member Services at 800.807.0764 or TTY 711 to request an appeal, or
• Submit the appeal of this decision in writing to VSP within 180 days from the date of the letter.  Please include a copy of the claim, as well as any comments that you would like to have considered.  Mail your appeal to:

                             VSP Vision Care
                             Attn: Claim Appeals
                             P.O. Box 2350 
                             Rancho Cordova, CA 95741

2. VSP has 30 days from the date it receives your request to resolve the complaint and send the resolution to you.

3. If the dispute is not resolved through the reconsideration process, you may request a review of the denial.  You must:

• Contact VSP Member Services at 800.807.0764 or TTY 711 to request an appeal, or
• Submit the appeal of this decision in writing to VSP within 180 days from the date of the letter.  Please include a copy of the claim, as well as any comments that you would like to have considered.  Mail your appeal to:              

                             VSP Vision Care
                             Attn: Claim Appeals
                             P.O. Box 2350 
                             Rancho Cordova, CA 95741

4. If you do not agree with the final decision, you may request an independent third party, mutually agreed upon by VSP and OPM, to review the decision.

The decision of the independent third party is binding and is the final review of your claim.  This decision is not subject to judicial review.

To initiate this process, you must submit the request for independent review to VSP, which has contracted with multiple, independent review organizations (IRO) that are fully accredited by URAC (a not-for-profit entity originally known as the Utilization Review Accreditation Commission).

                             VSP Vision Care
                             Attn: Claim Appeals
                             P.O. Box 2350 
                             Rancho Cordova, CA 95741

 You will be timely notified of the IRO decision.

The Federal employee, annuitant, or TRICARE-eligible individual enrolled in this plan.

This is the procedure used by the plan to pre-approve services and the amount that the plan will cover.

Generally, a sponsor means the individual who is eligible for medical or dental benefits under 10 U.S.C. chapter 55 based on their direct affiliation with the uniformed services (including military members of the National Guard and Reserves).

Under circumstances where a sponsor is not an enrollee, a TEI family member may accept responsibility to self-certify as an enrollee and enroll TEI family members.

TEI family members include a sponsor’s spouse, unremarried widow, unremarried widower, unmarried child, and certain unmarried persons placed in a sponsor’s legal custody by a court. Children include legally adopted children, stepchildren, and pre- adoptive children. Children and dependent unmarried persons must be under age 21 if they are not a student, under age 23 if they are a full-time student, or incapable of self-support because of a mental or physical incapacity.

VSP

Eye Exam – WellVision Exam, a comprehensive eye exam that focuses on your eyes and overall wellness.

$10 total copay for exam and/or glasses/necessary contact lenses

$0 copay at Premier Edge locations

Copay may apply

Reimbursed up to $45

International* up to $65

Prescription Eyewear:

Lenses – Glass or plastic single vision, lined bifocal, lined trifocal and lenticular lenses. Popular lens enhancements, including:

$10 copay for exam and/or glasses/necessary contact lenses

$0 copay for exam and/or glasses/necessary contact lenses at Premier Edge locations

Copay may apply

Reimbursed up to:

Single vision $45

Lined bifocal $65

Lined trifocal $85

Lenticular $125

International* up to:

Single vision $55

Lined bifocal $75

Lined trifocal $95

Lenticular $125

• Impact-resistant lenses (polycarbonate)

$0

Not Available

• Scratch-resistant coating

$0

Not Available

• TechShield anti-reflective coatings

$0

Not available

• Other anti-reflective coatings

$21-$65

Not Available

• Tints

$0

Not Available

• UV protection

$0

Not Available

• Light-reactive lenses, such as SynSync (clear indoors, dark outdoors)

$0

Not Available

• Standard progressive lenses

$0

Copay may apply

Reimbursed up to $65
International* up to $75

• Premium progressive lenses

$95-$105

Copay may apply

Reimbursed up to $65
International* up to $75

• Custom progressive lenses

$150-$175

Copay may apply

Reimbursed up to $65
International* up to $75

Frames

Frame allowance can be used towards one frame every calendar year

Copay may apply

Copay may apply

Reimbursed up to $47
International* up to $120

Featured Frame Brands at most in-network locations OR any frame at Visionworks

OR

Covered up to $250

Copay may apply

Reimbursed up to $47
International* up to $120

Standard frame allowance at in-network locations (including Walmart/Sam's Club)

$200

Copay may apply

Reimbursed up to $47
International* up to $120

Contact Lenses and Contact Lens Services (instead of glasses)

When you choose contacts instead of glasses, your $150 allowance applies to the cost of the contacts.

$150 allowance for contacts

Contact lens exam (fitting and evaluation) Up to $55 copay

Copay may apply

Reimbursed up to $105

International* up to $105

Medically Necessary Contact Lenses (instead of glasses)

Necessary contact lenses are a plan benefit when specific benefit criteria are satisfied and when prescribed by covered person's VSP network doctor or out-of-network provider. Review and approval by VSP are not required for covered person to be eligible for necessary contact lenses.

$10 copay

$0 copay at Premier Edge locations

Copay may apply

Reimbursed up to $210

International* up to $210

Additional Savings**

Prescription Glasses

• Average 30% savings on all other lens enhancements
• 20% savings on additional glasses and sunglasses from any VSP network doctor within 12 months of your last covered exam
• 20% savings on amount over the frame allowance and on additional eyewear

Contacts

• 15% savings on the cost of contact lens exam (fitting and evaluation)

Laser Vision Correction

• Average 15% off the regular price; discounts available at contracted facilities.

Retinal Screening

• Pricing on retinal screening not to exceed $39 as an enhancement to your WellVision Exam for members without diabetes.

**Based on applicable laws. Benefits may vary by doctor location. See your doctor for pricing.

Low Vision Coverage

• Low vision exams and low vision aids, every two years

Low vision benefits must be pre-authorized. If approved, covered every two years

You must pay the provider at the time of visit and submit claims to VSP for partial reimbursement. If your claim is approved, you will be reimbursed up to the maximum payable to a VSP network doctor.

VSP KidsCare

• Dependents under 18 have two fully covered WellVision Exams if needed.
• An additional set of lenses or contacts is covered in the same plan year, if needed. Minimum prescription change is required.

Any plan copays/allowances for exam and/or materials apply towards additional services.

Not Available

VSP LightCare

Visit a VSP network doctor and choose either prescription eyewear coverage or use your benefit toward ready-made:

• Non-prescription sunglasses or
• Non-prescription blue light filtering glasses

Copay may apply

Use frame allowance for ready-made non-prescription sunglasses, or ready-made non-prescription blue-light filtering glasses, instead of prescription glasses or contacts.

Copay may apply

Up to out-of-network reimbursement schedule for frame

Essential Medical Eye Care

• Includes an annual diabetic retinal screening with a $0 copay. 
• Helps treat immediate issues, such as pink eye or sudden changes in vision. 
• Helps with treatment to monitor ongoing conditions, such as dry eye, diabetic eye disease, glaucoma, and more. 
• Coordination with your medical coverage may apply. Ask your VSP network doctor for details.

$0 copay

Not available

Eye Exam - WellVision Exam, a comprehensive eye exam that focuses on your eyes and overall wellness.

$10 copay

$0 copay at Premier Edge locations

Copay may apply

Reimbursed up to $45

International* up to $65

Prescription Eyewear

Lenses - Glass or plastic single vision, lined bifocal, lined trifocal and lenticular lenses and popular lens enhancements, including:

$20 copay for lenses, frames, or necessary contact lenses

Copay may apply

Reimbursed up to:

Single Vision - $45

Lined bifocal - $65

Lined trifocal - $85

Lenticular - $125

International* up to:

Single Vision - $55

Lined bifocal - $75

Lined trifocal - $95

Lenticular - $125

Polycarbonate lenses (impact-resistant)

$0

Not Available

UV protection

$0

Not Available

Scratch-resistant coating

$0

Not Available

Standard progressive lenses

$0

Copay may apply

Reimbursed up to $65
International* up to $75

Premium progressive lenses

$95-$105

Copay may apply

Reimbursed up to $65
International* up to $75

Custom progressive lenses

$150-$175

Copay may apply

Reimbursed up to $65
International* up to $75

Anti-reflective coating

$41-$85

Not Available

Tints

$15-$17

Not Available

Frames

Frame allowance can be used towards one frame every calendar year

Copay may apply

Copay may apply

Reimbursed up to $47

International* up to $120

Featured Frame Brands at most in-network locations OR any frame brand at Visionworks 

OR

Covered up to $200

Copay may apply

Reimbursed up to $47

International* up to $120

Standard frame allowance at in-network locations (including Walmart or Sam's Club)

Covered up to $150

Copay may apply

Reimbursed up to $47

International* up to $120

Contact Lenses and Contact Lens Services (instead of glasses)

When you choose contacts instead of glasses, your $120 allowance applies to the cost of the contacts.

Covered up to $120

Contact lens exam (fitting and evaluation) Up to $55 copay

Copay may apply

Reimbursed up to $105

International* up to $105

Medically Necessary Contact Lenses (instead of glasses)

Necessary contact lenses are a plan benefit when specific benefit criteria are satisfied and when prescribed by covered person's VSP network doctor or out-of-network provider. Review and approval by VSP are not required for covered person to be eligible for necessary contact lenses.

$20 copay

Copay may apply

Reimbursed up to $210

International* up to $210

Additional Savings**

Prescription glasses

• Average 30% savings on all other lens options
• 20% savings on additional glasses and sunglasses from any VSP network doctor within 12 months of your last covered eye exam
• 20% savings on amount over the frame allowance and on additional eyewear

Contact lens care

• 15% savings on the cost of contact lens exam

Laser vision correction

• Average 15% off the regular price; discounts available at contracted facilities.

Retinal screening

• Pricing on retinal screening not to exceed $39 as an enhancement to your WellVision Exam for members without diabetes.

**Based on applicable laws. Benefits may vary by doctor location. See your doctor for pricing.

Low Vision Coverage

• Low vision exams and low vision aids, every two years

Low vision benefits must be pre-authorized.  If approved, covered every two years.

You must pay the provider at the time of visit and submit claims to VSP for partial reimbursement.  If your claim is approved, you will be reimbursed up to the maximum payable to a VSP network doctor.

VSP KidsCare

• Dependents under 18 have two fully covered WellVision exams if needed.
• An additional set of lenses or contacts is covered in the same plan year, if needed. Minimum prescription change is required.

Any plan copays/allowances for exam and/or materials apply towards additional services.

Not Available

LightCare

Visit a VSP network doctor and choose either prescription eyewear coverage or use your benefit toward ready-made:

• Non-prescription sunglasses or
• Non-prescription blue light filtering glasses

Copay may apply

Use frame allowance for ready-made non-prescription sunglasses, or ready-made non-prescription blue light filtering glasses, instead of prescription glasses or contacts.

Copay may apply

Up to allowed out-of-network reimbursement schedule for frame

Essential Medical Eye Care

• Includes an annual diabetic retinal screening with a $0 copay.
• Helps treat immediate issues, such as pink eye or sudden changes in vision.
• Helps with treatment to monitor ongoing conditions, such as dry eye, diabetic eye disease, glaucoma, and more.
• Coordination with your medical coverage may apply. Ask your VSP network doctor for details.

$0 copay

Not available