Follow the steps to complete the reimbursement request efficiently.

1. Press the ‘Get Form’ button to access the reimbursement request form and open it in the editor.
2. In the patient section, select the patient's relation to the member from the provided options and enter their date of birth in the format: Month/Day/Four-Digit Year.
3. Choose the patient's gender and fill in their last name and first name. Additionally, enter their address, including city, state, and ZIP code. The middle initial and ZIP+4 are optional.
4. In the member section, enter the last four digits of the member's SSN or unique ID number. If the patient is the member, indicate this by checking the relevant box. If not, proceed to enter the member's date of birth, gender, last name, first name, and address. The middle initial and secondary address line are optional.
5. In the claims section, provide the Date of Service in the designated format. Enter the amount charged for each line item, ensuring these amounts correspond to the receipts you will submit.
6. Select the lens type from the available choices. If applicable, check the box indicating another insurance company made payments and attach the relevant statement.
7. In the provider section, if known, fill in the provider's last name and first name, or their office name. Enter the first address line, city, state, and ZIP code; the second address line and ZIP+4 are optional.
8. In the print and sign section, review the completed form for accuracy. Read the acknowledgment paragraph, print the form, sign it, and date it in the designated format. Only the final request form needs to be mailed in; keep all other pages for your reference.

Complete your VSP Vision Care Request for Reimbursement online today to ensure a swift claims process.