Get Vsp Reimbursement Form

Filling out the VSP reimbursement form online can streamline the process of requesting reimbursement for your vision care expenses. This guide will provide you with comprehensive and easy-to-follow instructions to ensure that your form is completed accurately and efficiently.

Follow the steps to complete the VSP reimbursement form.

1. Click the ‘Get Form’ button to obtain the form and open it in your online editor.
2. Begin by entering the member information. Fill in the policyholder or employee ID or the last four digits of the Social Security Number, followed by the user's first name, last name, date of birth, and address. Be sure to include the apartment number, city, state, and zip code.
3. Next, provide the employer or group information as well as the daytime phone number.
4. Fill out the patient information section by selecting whether the patient is a member, spouse, child, or domestic partner and entering their relevant details, including date of birth.
5. If the patient is a child over the age of 18, indicate whether they are a full-time student or if they have a disability by checking the appropriate boxes.
6. In the claim information section, input the dollar amounts for the services rendered. Enter amounts for lens types, exam fees, frames, and contacts. Ensure total amounts match the attached itemized receipts.
7. Specify the date services were received and indicate if an additional insurance company has made a payment. If applicable, attach a copy of the payment statement.
8. Provide the provider information, including the store or doctor's name and phone number.
9. Sign the form in the designated area, acknowledging that all information provided is complete and accurate.
10. Finally, save the changes to your document. You may then download, print, or share the completed form for submission.

Start completing your VSP reimbursement form online today to ensure timely processing of your reimbursement request.