VSP Flex AllowanceTM
Effective January 1, 2026, eligible members will have an additional allowance to use on frames, lenses, including lens enhancements, or contacts.
Eligibility
Eligible members will be indicated with coverage details on the Patient Record Report under Plan Details with the heading of Flex Allowance.
Exam Coverage
No Exam coverage
Materials Coverage
Lenses and Frames
Patients are eligible to use the allowance toward prescription lens, lens enhancements and/or frame (complete pair not required) up to the group-specific schedule of allowance. The lens allowance is applied to the complete lens service—including both the base lens and any lens enhancements selected. Patient pays the amount over their allowance.
A combined allowance applies to only one set of services. Your patients may use their benefits for a complete pair of prescription glasses or contact lens exam/materials.
VSP only covers frames that are used for prescription lenses that meet VSP’s minimum prescription criteria (refractive error is at least +/- 0.50 diopter), unless the patient has plano coverage.
Refer to coverage details on the Patient Record Report under Plan Details.
Contact Lenses
Charge patients 85% U&C for contact lens exam services (evaluation/fitting services and follow-up services) and 100% U&C fees for contact lens materials less plan allowance. Elective contact lenses are chosen in place of a complete set of prescription glasses. Your patient must pay any costs over the allowance listed in their group-specific schedule of allowances.
Lab
Lab work is handled privately. You may provide lenses through any lab, including in-office labs.
Submitting the Claim Electronically
Glasses:
Bill using our electronic claims submission system.
- Complete the Invoice Services page and select Non-VSP lab (Private Invoice).
- Click on the Calculate HCPCS and Continue button.
- Complete the Diagnosis and Services page by entering your full U&C fees next to the appropriate CPT/HCPCS code.
Contact Lenses:
Bill using our electronic claims submission system.
- Choose the type of contacts dispensed.
- If contact lens evaluation/fitting services were provided, show this in the dropdown.
- Click on the Calculate HCPCS and Continue button.
- Complete the Diagnosis and Services page by entering your full U&C fees next to the appropriate CPT/HCPCS code.
Submitting the Claim on Paper
Glasses:
- Enter your full U&C fees next to the right CPT/HCPCS code.
- Complete the CMS-1500 Claim Form by entering your full U&C fees next to the right CPT/HCPCS code for lens and frame.
- Enter all eight digits of the authorization number in Box 23.
Contact Lenses:
- Enter your full U&C fees next to the right CPT/HCPCS code.
- Select the type of contacts dispensed.
- Enter all eight digits of the authorization number in Box 23.
Coordination of Benefits
Some members may be able to use their Flex Allowance coverage towards overages from their first-pair coverage if their plan includes COB rule 11 - Employees and dependents can use their second-pair coverage towards overages from their first-pair coverage.
Refer to coverage details on the Patient Record Report under Patient Coverage details section with the heading of Coordination of Benefits.
Claims Submission
To coordinate with their first-pair coverage:
- If electronic, enter the Flex Allowance authorization number in the VSP Secondary COB Authorization box in eClaim.
- If billing on paper, enter the Flex Allowance authorization as "Secondary COB auth ########" in Box 19.