Vision Care Program - CalHR

Benefits Administration Manual - Vision Care Program

 

Content

Attachments

  

Questions Regarding the State Vision Program for Actives and Retirees/Annuitants

If you are an active State employee, please contact your department's personnel/human resources' office. For Personnel Office Staff requiring assistance or clarification regarding active employees in the State's vision program, please email  LaTrice Moore at LaTrice.Moore@calhr.ca.gov . If you need information regarding the State retiree/annuitant vision program, please call Sue Odom at (916) 322-2858.

2014 VISION Program Updates

The following are highlights of changes in the Vision Program for 2014.

 

The 2014 Open Enrollment period for Vision is September 15, 2014 through October 10, 2014. Please remember that all eligible active employees will receive open enrollment materials at the home mailing address they have on file with SCO. There should be no open enrollment vision transactions through any personnel offices. If open enrollment has begun and the employee has not received their open enrollment materials by mail  from VSP directly, please direct the employee to VSP only during open period dates by phone 800-877-7195. Also, if you have new employees/newly eligible employees during the open enrollment period, all newly eligible employees who choose to elect Premier vision within 60 days of their new eligibility date, should complete the Premier Vision Form (CalHR 774) and submit to their own personnel office for processing.
 
Effective February 2014, when vision plan appeals for active employees are filed through CalHR requiring retroactivity, a brief sentence will need to be included in the appeal stating that the employee authorizes VSP to direct bill for any retroactive Premier premiums until SCO begins the warrant deductions or just a note at the top of the appeal that states "OK TO DIRECT BILL" to authorize a retroactive effective date.
 

Note to personnel:

For any permanent full-time employee choosing to enroll in the VSP Premier plan, personnel must FIRST key the employee's PAR information so the employer contribution/deductions will begin.

1201. General Information

The California Department of Human Resources (CalHR) administers the State's Vision Care Program and maintains the contract between the State and the carrier. The current carrier, Vision Service Plan (VSP), provides vision coverage plans (State of California Plan group number - Basic Plan 12020000), (State of California Plan group number - Premier Plan 30034581) (State of California Retiree Vision Plan group number 12294067 - for retirees/annuitants).
 

Authority

CalHR Rule 599.927 - Non-Represented Employees
Memoranda of Understanding - Rank and File Employees
Government Code 22959.1 - 22959.6 - Retirees/Annuitants 

1202. Eligibility - BASIC & PREMIER

Employees

State employees designated rank and file, managerial, supervisory, confidential, and all other employees excluded from collective bargaining, Constitutional Officers, employees of the Judicial Council, Supreme, Appellate, and Superior Court Judges who meet the following criteria:
 
  1. A permanent employee appointed half-time or more.
  2. An employee appointed limited-term (LT) or temporary authorization (TAU) for six months or more with a time base of half-time or more.
  3. A permanent intermittent employee who works a minimum of 480 hours in a six-month qualifying control period (January 1-June 30 and July 1-December 31).
  4. A former retired State employee who is currently enrolled in State COBRA vision benefits and/or Retiree Vision Program and reinstates as a permanent intermittent.
  5. An employee appointed under Government Code Section 21228.
  6. Eligible Seasonal Lifeguards (Unit 7) as defined by Bargaining Unit 7 MOU
  7. Eligible Seasonal Firefighters (Unit 8) as defined by Bargaining Unit 8 MOU.
 
Employees in Bargaining Unit 6 - California Correctional Peace Officers Association (CCPOA) have vision coverage through their union benefit trust and are not eligible to enroll in the State's Vision Program as an active employee; however, upon retirement, they're eligible for the state Retiree Vision Program. The personnel office should offer these individuals the state Retiree Vision Program at retirement. Any questions regarding BU 6 Non-Supervisor (CCPOA) member information should be directed to CCPOA.
 
All active State employees (with the exception of rank and file BU 6 employees, as their vision benefits are provided by their union trust) are eligible to enroll in the Premier Plan.

FOR RETIRING EMPLOYEES 

Employees who are retiring from the state may enroll in the Retiree/Annuitant Vision Program. They must meet the requirements of Government Code Section 22959.4 at the time of retirement (as reflected below).
 

The following retiring employees are eligible to enroll:

 
  1. A civil service employee of the state.
  2. An elected member of the Legislature.
  3. A legislative employee.
  4. A constitutional officer.
  5. An employee, judge, or justice of the judicial branch of state government.

 

When an employee retires, personnel office MUST offer retiree vision or COBRA continuation of active State coverage.

 

Enhanced Vision Plan for Retirees? 

Currently there is not a Premier vision (enhanced) plan for retirees/annuitants. However, if a retiring employee is already enrolled in the Premier vision plan for active employees at the time of retirement, then the retiring employee may continue the Premier through COBRA only up to 18 months by completing the CalHR 774 Premier Vision Form and checking the "New COBRA Enrollment" box.

 
Retirees/Annuitants of the California State University (CSU) and University of California (UC) systems may not participate in this vision program.  

FOR SURVIVORS 

Eligible survivors (survivorship as determined by CalPERS), may enroll in the Retiree/Annuitant Vision Program.

Retirees/Annuitants Eligibility (G.C. Sec. 22959.4 requirements)

State retirees/annuitants are eligible for enrollment into the Retiree Vision Program if any of the following apply:

 
  1. (a.) The retiree/annuitant was enrolled in a health benefit plan, a dental care plan, or vision care plan at the time of separation for retirement, and retired within 120 days of the date of separation from the State. (b.) The retiree/annuitant was not enrolled in a health benefit plan, a dental care plan, or vision care plan at the time of separation or retirement, but was eligible for enrollment as an employee at the time of separation for retirement, and retired within 120 days of the date of separation from the State.
  2. The annuitant is part of the Legislators' Retirement System receiving an allowance pursuant to Article 6 (commencing with Section 9359) of Chapter 3.5 of Part 1 of Division 2.
  3. An annuitant is part of the Judges Retirement System I or II, and receiving an allowance from either system.
 
A person who was enrolled in a vision care plan at the time he or she became an annuitant under state or federal provisions, may continue his or her enrollment, including eligible family members, without discrimination as to benefit coverage as an enrolled person within this program.
 
Note to Personnel: To enroll a survivor and dependents into the retiree vision program, before the 120 day benefit is completed, please send a fax a completed CalHR 695 Retiree Vision Form to CalHR Fax 916.322.3769. PLEASE INDICATE "Survivor Benefit" at the top of the CalHR 695. In the remarks section, please include the deceased employee's full name, dob and full ssn for reference. Be sure to complete the party code, retiree vision premium amount, effective date, agency contact information and necessary signatures.
  

Dependents of Employees and Retirees and Annuitants Eligibility

Eligible Dependents include

  1. Spouse or Domestic Partner;
  2. Dependent children under the age of 26. Children include: natural, adopted or step children or a child living in a parent-child relationship who is economically dependent upon the employee (until the end of the month in which they reach age 26).

Ineligible Dependents

A covered spouse, domestic partner, or dependent children lose vision coverage when any of the following occurs:
  1. An employee permanently separates from employment or reduction of hours (which causes loss of coverage);
  2. The death of employee;
  3. Divorce or termination of domestic partnership from employee;
  4. Child ceases to be a dependent (e.g., child turns age 26).

 

Disabled Dependent Children

An eligible dependent who is under the age of 26 years and who is enrolled as an eligible family member, and living in the employee's or annuitant's household, may continue to be enrolled after attaining age 26 if he/she is incapable of self support because of physical disability or mental incapacity and if he/she is dependent upon the eligible employee or annuitant for support and care.
 

The disabled dependent may be continued under such coverage only under the following conditions:

  1. The dependent was eligible as a disabled child at the time of the employee's initial enrollment; or
  2. The dependent became disabled while enrolled as an eligible family member prior to attaining age 26.
 
The employee must provide satisfactory evidence of the disability, within a period starting 60 days before and ending 60 days after the employee's initial enrollment or the dependent's 26th birthday. An approved copy of a CalPERS Medical Report for Disabled Dependent (HBD-34) must be sent to the vision carrier. Annual certification of continued disability may be required.
 

The following disabled dependents are excluded from coverage:

  1. Dependent whose disability occurred after age 26.
  2. Dependents over age 26 who were not enrolled at the initial enrollment of the employee.
 

Retiree Vision Program Only:

Dependents over age 26 who were enrolled in, and later deleted from the Retiree Vision Program are excluded from coverage. 

1203. Enrollment

Basic Vision Plan 

Enrollment into the State's Basic Vision Plan for eligible employees and their eligible dependents is automatic. The effective date of enrollment is based on when the Personnel Office keys an employee's Personnel Action Request (PAR) document into the State Controller's Office (SCO) payroll system. Eligible dependents are automatically enrolled at the same time that an employee's enrollment becomes effective. (Note: STD. 700 must be completed for Permanent Intermittent employees' enrollments.)

 
The vision coverage will be effective the first of the following month if the employee's PAR document is keyed into the SCO system prior to the 10th of the month (see Example 1 below). The vision coverage will be effective the first of the second month if the employee's PAR document is keyed into the SCO system after the 10th of the month (see Example 2 below).
 
  • Example 1: An employee is appointed on the 3rd and the PAR document is keyed prior to the 10th of the month. The coverage is effective on the first of the following month.
  • Example 2: An employee is appointed on the 3rd and the PAR document is keyed after the 10th of the month. The coverage is effective on the first of the following second month.
 

Vision Plan Enrollment Authorization Form (STD. 700)

The Vision Plan Enrollment Authorization (STD. 700) is used in certain situations to enroll eligible employees in the State Vision Program. See Attachment A - Vision Plan Enrollment Authorization (STD. 700) for a copy of the STD. 700 and Section 1210 for completion instructions. 

SITUATIONS THAT REQUIRE THE COMPLETION OF A STD. 700

The following situations will require completion of a Vision Plan Enrollment Authorization, STD. 700 to enroll in or cancel coverage. See Attachment C - Permitting Event Codes/Effective Dates Chart - Basic Vision Plan for information regarding permitting event codes.

 
  1. An employee who is eligible, but did not enroll, prior to implementation of the automatic enrollment.
  2. A permanent-intermittent employee who works a minimum of 480 hours in a six-month qualifying control period (January 1-June 30 and July 1-December 31).
  3. A former retired State employee who is currently enrolled in State COBRA vision benefits and reinstates as a permanent intermittent.
  4. A permanent-intermittent employee cancellation due to loss of eligibility.
  5. An employee who declines or cancels coverage may do so by completing a STD. 700 form. If later the employee decides to re-enroll, another STD. 700 must be completed.  The vision benefit is mandatory under the Consolidated Benefits Program (CoBen), and employees in CoBen may not cancel their State-sponsored vision coverage.
  6. An employee and/or eligible dependent who elects to continue the vision coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA) Program. (see Benefits Administration Manual (BAM) COBRA Section 400)
  7. A permanent intermittent employee in BU 6 who is eligible following graduation from the academies of the California Department of Corrections and California Youth Authority. 

 

PERMANENT INTERMITTENT EMPLOYEES ENROLLMENT INTO PREMIER VISION PLAN

For permanent intermittent employees wanting to enroll into the Premier Vision Plan, the STD. 700 needs to be completed in order to process the employer's contribution and deduction. In addition to the STD. 700, the CalHR 774 MUST ALSO be completed in order to enroll a member into Premier Vision. The STD. 700 should be sent to SCO and the CalHR 774 is to be sent to VSP's mailing address.

 

Premier Vision Plan


All active State employees (with the exception of rank and file BU6 employees, as their vision benefits are provided by their union trust) are eligible to enroll in the Premier Plan.  See  Attachment B - Premier Vision Enrollment Authorization (CalHR 774) for a copy of the CalHR 774 and Section 1211 for completion instructions. Eligible State employees enrolled in this plan shall be required to pay a minimal premium. When the employee enrolls in the premier, the entire family, if applicable, also must be enrolled in premier. Employees may add dependents after open enrollment only if family status changes (permitting event) , as defined by the State, has occurred. 
 

12-Month Minimum Enrollment Period for Premier Vision


For employees wanting to enroll into the Premier Vision Plan, they must positively elect to enroll. Once enrolled into the Premier plan, the employee will be required to maintain their enrollment for a 12-month minimum enrollment period. An employee enrolled into this program may disenroll during any open enrollment period, with their enrollment ending January 1 of the next calendar year (after they have completed the minimum 12-month enrollment period). An employee that decides to disenroll from the Premier plan after their minimum 12-month enrollment period may do so during open enrollment. Employees disenrolling may not re-enroll until the next open enrollment period (unless they experience a permitting event that will allow an enrollment prior to open enrollment). 
 
Note: The required enrollment period can extend beyond 12 months. Example; New employee enrolled in the premier plan on June 1. As long as they are elgible for benefits, they will be required to maintian their enrollment into the next calendar year. The next point they could disenroll will be open enrollment with an effective date fo the first of the next year.
 

Example Scenario:

 
Enrollment is June 1, 2013 with employee having continued benefit eligibility.
Next point of disenrollment being possible: Open enrollment (OE) of 2014.
If disenrollment elected during OE period, disenrollment will be effective January 1, 2015.
 

Appearance of Premier Vision Deduction on Employee's Warrant Stub

 

COBEN EMPLOYEES

The $8.64 State contribution is part of the CoBen allowance. With the new premier vision plan, when an employee is enrolled into the premier vision plan, the $8.64 is still present in the allowance and $8.64 is still paid to VSP as the employer share of this plan. The balance or employee share (PC1 $6.56, PC2 $13.12, or PC3 $21.12) is reported as a separate miscellaneous deduction. Both deductions are itemized on the warrant stub to verify the deductions occurred and paid to VSP.
 

NON-COBEN EMPLOYEES

The $8.64 State contribution is still paid for by the state for non-coben employees. With the new premier vision plan, when an employee is enrolled into the plan, the $8.64 is still present as the employer contribution and $8.64 is still paid to VSP as the employer share of this plan. The balance or employee share (1 Party $6.56, 2 Party $13.12, or 3 Party $21.12) is reported as a separate miscellaneous deduction. Both deductions are itemized on the warrant stub to verify the deductions occurred and paid to VSP.
 

Deduction Detail Example:

 

Example of what benefits allowance and deductions can look like on SCO payroll (here an excluded employee):

Allowance amount shows on both sides for accounting - (shows as negative on the left with premiums applied):
 

State Share (here CoBen Allowance - excluded employee):

1448.00 (Party Code Employee plus 2 or more dependents)
 

Health Premium:

1584.28 Health premium amount (shown as family code for Kaiser)
 

Dental Premium: 

160.40  Dental premium amount (shown as Delta Premier Enhanced)
 

Vision premium charge - against State Share (allowance):

8.64 (shown here as the $8.64 amount, credit against State share component of allowance)

21.12 premier vision plan premium cost share (employee share - miscellaneous deduction)
 
Sample (redacted view from the State Controller’s payroll system - example)
 
State share shows on both sides for accounting purposes

354 010  1448.00-*                   FC         1448.00 State Share (here CoBen allowance for Excluded employee)*
350 056  1584.28 *                   FH                .00    Health plan premium amount
351 008   160.40 *                    FD                .00    Dental plan premium amount
475 002     8.64 *                       HV                .00    Vision plan State share charge against allowance
361 475    21.12 *                     FM                 .00    Premier plan employee cost share deduction

*For CoBen employee, the CoBen allowance is built from three components, the basic vision plan premium amount, currently $8.64, 75% of the Delta Premier plan premium amount, and the weighted amount for health (dependent upon bargaiing unit). Amounts combined equal the CoBen allowance. 
  

CoBen Cash

For employees in CoBen cash, you’ll see a -$8.64 on the warrant itemization (right side on the warrant stub) to show basically the payment of the State share for the vision plan, but it will show in the lower left the employer contribution in total (CoBen Cash amount + the 8.64 for the vision [in total it looks like either 138.64 or 163.64]). CoBen cash is paid as a component of taxable salary. Payment amount of the CoBen cash is shown on the left side of the warrant stub (upper).
  

Enrollment into Retirement Vision Plan

When an employee retires, they must be offered COBRA continuation for the State active employee vision coverage (please see BAM COBRA Section 400 for information on "Retiree Benefit Alternate Coverage"). Retiring employees must also be offered the Retiree Vision Program at the time of retirement. If the retiring employee elects the retiree vision plan, they will need to complete a CalHR 695 then return to their personnel office. See Attachment E - Retiree Vision Plan Enrollment Authorization (CalHR 695) for a copy of the CalHR 695 and Section 1213 for completion instructions. Offer of the Retiree Vision Program should be made along with the offer of continuation of other benefits into retirement. All eligibility and enrollment information should be sent to deceased employees' eligible survivors, including COBRA notices.
 
Departments with CCPOA employees must continue to offer COBRA to retiring CCPOA employees to continue their active employee vision coverage (if not available through CCPOA trust into retirement) along with offering the Retiree Vision Program. CCPOA covered enployee should contract the CCPOA benefits trust for more information on the CCPOA sponsored vision plan.

CONTINUATION OF PREMIER VISION PLAN THROUGH COBRA 

For retiring employees who are already enrolled in Premier vision and wish to continue their enhanced benefit, the employee may continue Premier through COBRA for up to 18 months. A CalHR 774 Premier Vision Enrollment form must be completed and the New COBRA enrollment box would need to be checked on the form. See Section 1214 for COBRA Premier vision premiums.
 
Personnel office must offer COBRA for employees who are retiring and are enrolled in the Premier vision plan.  Premier vision plan is not available to retirees outside of COBRA continuation. Retirees may enroll into the retiree vision plan upon the end of their Premier plan through COBRA continuation.
 
The Personnel Office will need to advise the employee at the time of retirement about the Retiree Vision Program and assist them with the enrollment process. After the initial enrollment is processed by the vision plan, then the retiree/annuitant should contact the vision plan to report applicable permitting events. Once enrolled in the Retiree Vision Program they do not have to re-enroll each year.
 
PLEASE REMEMBER that while CalHR sets policy and procedures on enrollment and eligibility, the actual enrollment form, Vision Plan Enrollment Authorization (STD. 700) is reviewed and processed for active employees by the State Controller's Office (SCO). The Premier Vision Enrollment Authorization (CalHR 774) is reviewed and processed by Vision Service Plan. The Retiree Vision Plan Enrollment Authorization (CalHR 695) is reviewed and processed by Vision Service Plan, with deductions taken by the applicable retirement system (California Public Employees' Retirement System [CalPERS], and Judges and Legislative Retirement Systems [JRS/LRS]. Only those forms requesting some type of appeal or exception are forwarded to CalHR for review. 
 

12-Month Minimum Enrollment Period for Premier Vision

Once enrolled into the Retiree Vision Program, the employee will be required to maintain their enrollment for a 12-month minimum enrollment period. An employee enrolled into this program may disenroll during any open enrollment period, with their enrollment ending January 1 of the next calendar year (after they have completed the minimum 12-month enrollment period). An employee that decides to disenroll from the Premier Vision Program may not re-enroll until the next open enrollment period (unless they experience a permitting event that will allow an enrollment prior to open enrollment). 

OPEN ENROLLMENT 

Basic Vision Plan

 

Eligible active employees enrolled in the Basic Vision Plan do not have an open enrollment period because the enrollment in the state's basic vision coverage is automatic. Employees who are eligible, but did not enroll, prior to implementation of the automatic enrollment may enroll outside of the open enrollment period.  Permanent Intermittent (PI) employees may not enroll during an open enrollment period because they must complete a PI control period in order to be eligible for enrollment in the vision plan.
 

Premier Vision Plan

 
An employee must elect to enroll into the Premier Vision Plan. Once enrolled into the Premier Vision Plan, the employee will be required to maintain their enrollment for a 12-month minimum enrollment period. An employee enrolled into this program may disenroll during any open enrollment period, with their enrollment ending January 1 of the next calendar year (after they have completed the minimum 12-month enrollment period). An employee that decides to disenroll from the Premier Vision Plan may not re-enroll until the next open enrollment period (unless they experience a permitting event that will allow an enrollment prior to open enrollment).
 

Retiree Vision Plan


Retirees and annuitants who are not enrolled in the Retiree Vision Program will receive annual open enrollment information from the vision plan carrier. Retirees and annuitants who are enrolled in the Retiree Vision Program will receive open enrollment information from CalHR Benefits Division. The effective date of any action during open enrollment is January 1, of the following year. 

MONTHLY PREMIUMS 

Basic Vision Plan


The State is responsible for the monthly premium to VSP for eligible active employees enrolled in the Basic Vision Plan. The State contribution amount appears on covered employees' statements of earnings and deductions. The monthly premium covers the employee and all eligible dependents (see Section 1214 for premiums and vision plan address).
 
Employees in Consolidated Benefits (CoBen) will have the monthly premium amount deducted from their monthly CoBen allowance (as shown on their monthly statement of earnings and deductions). The monthly premiums for the Retiree Vision Program are fully paid by the retiree/annuitant. Once enrolled, CalPERS will make a monthly deduction from their warrant. If there are insufficient funds to make a deduction, Vision Service Plan will direct bill the annuitant for the cost of the monthly premiums.
 

California State Teachers' Retirement System (CalSTRS) retirees will be direct billed for their monthly premium.

 
For those persons who are in the Direct Billed part of this program, enrollment length is still the same; failure to continue payment will mean retiree/annuitant and any enrolled dependents will become ineligible and the annuitant will be disenrolled until the next open enrollment period and plan year. Grace period will be 60 days, after which time annuitant will be dropped from the plan. This payment failure is considered a voluntary action.
 

Premier Vision Plan


The State will continue to pay the employer share per month per eligible enrolled employee for those employees enrolled in the State Premier Vision Plan. 

EFFECTIVE DATES  

Effective Dates for the Completed STD. 700 for Active Employees – Basic Vision Plan
Enrollment documents received at SCO will be effective with a standard or mandatory effective date. See Attachment C - Permitting Event Codes/Effective Dates Chart – Basic Plan for effective date information.
 
Effective Dates for the Completed CalHR 774 for Active Employees – Premier Vision Plan
Enrollment documents received at VSP will be effective with a standard or mandatory effective date. See Attachment G - Permitting Event Codes/Effective Dates Chart – Premier Plan for effective date information
 
Effective Dates for the Completed CalHR 695 for Retirees/Annuitants
Enrollment documents received at VSP will be effective with a standard or mandatory effective date. See Attachment G - Permitting Event Codes/Effective Dates Chart - Retirees for effective date information. After the initial enrollment is processed by the vision plan, then the retiree/annuitant should contact the vision plan to report applicable permitting events.
 

Deletion of Ineligible Dependents 

The completion of a STD.700 or CalHR 774 is required for deleting ineligible dependents off an active employee’s vision plan.  Deletion documents will need to be sent to Vision Service Plan with a copy retained in the employee’ s personnel file. The CalHR 695 is not required for deletion of ineligible dependents. Employees who have dependents should be advised that ineligible dependents are not permitted to use the State's vision plan. Employees and retirees will be held liable for payment of services that are provided to ineligible dependents. 

1204. The Vision Benefit - Basic and premier

Vision Service Plan is providing State-sponsored vision benefits. Please check with VSP provider for benefit details. The Basic Vision Plan is designed to encourage employees, retirees, and their eligible dependents to maintain vision through regular eye examinations and to help with vision care expenses for required glasses and contact lenses.
 
The Premier Vision Plan is for employees and their dependents who want a richer plan for their vision care needs.
 
When retiring employees enroll in the Retiree Vision Program they are eligible for a new set of benefits (including their eligible dependents). Currently the Premier plan is not a plan option for retirees.
 

Basic Vision Plan


Standard Eye Examination and Glasses:
 
  • Eye Examination: Once every calendar year
  • Spectacle Lenses: Once every calendar year
  • Frame: Once every calendar year - $75 allowance
 
Copayments:
 
  • Eye examination: $10.00
  • Lenses and/or a frame: $25.00
 
Contact Lenses:

Elective or Medically Necessary contact lenses may be chosen instead of glasses. A $110 allowance will be provided towards the standard eye examination, contact lens evaluation examination, fitting costs, and materials. Any costs exceeding the allowance are the responsibility of the employee/dependent.

Visually Necessary contact lenses are covered in full when prescribed by a VSP member doctor with prior authorization from VSP.
 

Premier Vision Plan


Standard Eye Examination and Glasses:
 
  • Eye Examination: Once every calendar year
  • Spectacle Lenses: Once every calendar year
  • Frame: Once every calendar year - $200 allowance

 

Copayments:

 

  • Eye examination: $10.00
  • Lenses and/or a frame: $25.00
 
Contact Lenses:

Elective or Medically Necessary contact lenses may be chosen instead of glasses. A $200 allowance will be provided towards the standard eye examination, contact lens evaluation examination, fitting costs, and materials. Any costs exceeding the allowance are the responsibility of the employee/dependent.

Visually Necessary contact lenses are covered in full when prescribed by a VSP member doctor with prior authorization from VSP. 

1205. How to Use the Plan - BASIC & PREMIER

An eligible employee/dependent may choose to receive vision care services from a VSP Member Provider or any other licensed optometrist, ophthalmologist, or optician. 
 

Steps when using a VSP Doctor 

  1. Select a VSP doctor. If employees/retirees/dependents need help locating one, phone VSP at 1 (800) 877-7195 or access the VSP website.
  2. The employee/retiree/annuitant/dependent should call the VSP doctor for an appointment and indicate that they are enrolled under the VSP plan. Simply provide the employee's name and social security number. Active employees and eligible dependents are under plan group number 12020000 (State of California). Retirees/annuitants and eligible dependents are under plan group number 12294067 (State of California).
  3. The doctor and VSP will handle the rest. The doctor will contact VSP to verify eligibility and plan coverage. If the employee/retiree/dependent is not eligible at the time, then the doctor will inform the employee/retiree/dependent. If the employee/retiree/dependent is eligible, then payment for any applicable copayments is required at the time of the appointment. VSP will pay the doctor directly for covered services. 
 

When Not Using a VSP Doctor 

Employees/retirees/dependents may obtain covered services or materials from any other licensed optometrist, ophthalmologist, or optician of their choice. Services obtained through non-member doctors are subject to the same deductibles and limitations as services through VSP member doctors. The doctor must be paid in full and an itemized receipt is submitted to VSP. VSP will reimburse the employee/retiree/dependent up to the amounts allowed under the State plan's non- member doctor schedule. The reimbursement schedule does not guarantee full payment nor can VSP guarantee patient satisfaction when services are received from a non-member doctor.

 
All claims must be filed within six months of the date services were completed. Reimbursement benefits are made directly to the covered employee/retiree/annuitant/dependent and are not payable to the doctor.
  

EXCLUSIONS AND LIMITATIONS - Basic Plan

 
Your vision plan is designed to cover visual needs rather than cosmetic eyewear. If you select any of the following extras, the plan will pay the basic cost of the allowed lenses and you will be required to pay any additional costs associated with these extras:
1. Blended lenses
2. Contact lenses
3. Oversize lenses
4. Progressive multifocal lenses
5. Coated or laminated lenses
6. Frame costing more than plan allowance
7. UV protected lenses
8. Other optional cosmetic processes

The following services or eyewear are excluded under your plan:
1. Orthoptics; vision training; any associated
2. Supplemental testing
3. Plano lenses
4. Two pairs of glasses in lieu of bifocals
5. Replacement or repair of lost or broken lenses or frames prior to service eligibility
6. Medical or surgical treatment of the eyes
7. Services or eyewear covered under Worker’s Compensation
8. Eye exams required as a condition of employment
9. Services or eyewear provided by any other group benefit vision care program
 

EXCLUSIONS AND LIMITATIONS - Premier Plan


Your vision plan is designed to cover visual needs rather than cosmetic eyewear. If you select any of the following extras, the plan will pay the basic cost of the allowed lenses and you will be required to pay any additional costs associated with these extras:
1. Contact lenses
2. Oversize lenses
3. Coated or laminated lenses
4. Frame costing more than plan allowance
5. UV protected lenses
6. Other optional cosmetic processes

The following services or eyewear are excluded under your plan:
1. Orthoptics; vision training; any associated supplemental testing
2. Plano lenses
3. Two pairs of glasses in lieu of bifocals
4. Replacement or repair of lost or broken lenses or frames prior to service eligibility
5. Medical or surgical treatment of the eyes
6. Services or eyewear covered under Worker’s Compensation
7. Eye exams required as a condition of employment
8. Services or eyewear provided by any other group benefit vision care program
 

    NON-VSP PROVIDER REIMBURSEMENT SCHEDULE
    Availability of services under the reimbursement schedule is subject to the same time limits and copays as those described for VSP network doctor services. Services obtained from a non-VSP provider are in lieu of obtaining services from a VSP network doctor. Reimbursement benefits are not assignable.

    PROFESSIONAL SERVICES - Basic Plan:
    Vision Exam, up to...............................................$35
    EYEWEAR
    Single Vision Lenses, up to..................................$25
    Lined Bifocal Lenses, up to..................................$50
    Lined Trifocal Lenses, up to.................................$50
    Lenticular Lenses, up to.......................................$100
    Frame, up to.........................................................$40
    Tint Allowance......................................................$5
    CONTACT LENSES*
    Necessary, up to..................................................$250
    Elective, up to......................................................$110
     
    PROFESSIONAL SERVICES - Premier Plan:
    Vision Exam, up to ...............................................$45
    EYEWEAR
    Single Vision Lenses, up to..................................$30
    Lined Bifocal Lenses, up to..................................$50
    Lined Trifocal Lenses, up to.................................$65
    Lenticular Lenses, up to.......................................$100
    Frame, up to ........................................................$70
    Tint Allowance .....................................................$5
    CONTACT LENSES*
    Necessary, up to..................................................$250
    Elective, up to.......................................................$105

    * Determination of “necessary” versus “elective” contact lenses under the non-VSP reimbursement schedule will be consistent with VSP network doctor services. Reimbursement for contact lenses is in lieu of all benefits, including exam and eyewear services.
 

 1206. coordination of benefits-dual coverage

Coordination of Benefits


Covered Persons who are covered under two or more insurance plans that include vision care benefits may be eligible for Coordination of Benefits (“COB”). VSP will combine other insurance plans’ claim payments or reimbursements, if any, with benefits available under Covered Person’s VSP Plan, which may reduce or eliminate covered person’s out-of- pocket expense. Covered persons covered under more than one VSP Plan may also be able to take advantage of COB.
 

Dual Coverage


A married enrollee whose spouse is also an enrollee under his/her own VSP Plan may coordinate benefits between their respective VSP Plans. Such “dual coverage” will be subject to the same procedures and limitations applicable to coordination of benefits with non-VSP plans.

Eligible married State employees or those State employees with eligible domestic partners may co- cover each other under the State’s Vision Program. This option also applies to their dependent children, including dependents of domestic partners. The procedure for coordination of Dual coverage benefits will be available as follows:

     a)  Eligible married State employees or those State employees with eligible domestic partners can receive benefits under each other’s plan and receive two pairs of eyeglasses subject to the independent deductibles and all other plan limitations. Dependent children can receive one pair of eyeglasses under either their father’s or mother’s plan, or both, subject to the deductible and plan limitations. In both instances, this provision applies to the active basic and annuitant plans, as well as the premier vision plan.

     b)  Eligible married State employees or those State employees with eligible domestic partners cannot use their secondary coverage to cover the cost of extras.

     c)  If an Eligible Employee receives only one pair of eyeglasses, the deductible may be paid by the secondary coverage. In order to process claims involving COB, VSP may need to share personal information regarding Covered Persons with other parties (such as another insurance company). When this is necessary, VSP will only share such information with those persons or organizations having a legitimate interest in that information and only where such sharing is not prohibited by law. 
 

Retirees/Annuitants


Married Retirees/Annuitants and registered domestic partners have dual coverage under the State Vision Program if they are enrolled as a dependent on each others' plan. Dual vision coverage also applies to dependent children if they are enrolled as a dependent on each eligible Retiree's/Annuitant's plan (either married or registered domestic partnership).
 

To utilize this feature of the Vision Program, verification of eligibility must be obtained from VSP for both the retiree and annuitant. One verification will authorize coverage as the retiree/annuitant and the other verification will authorize coverage as a spouse/domestic partner. Verification of eligibility for both retirees/annuitants should be obtained by the member provider on the initial visit. When services are obtained from a non-member provider, an itemized receipt must be returned to VSP and verification of eligibility should be obtained by the provider.
 

Dual coverage is permitted for the following scenarios:
1. Retired member is enrolled in the Retiree Vision Program, and they are the spouse or domestic partner of an active employee, enrolled in the State active vision plan.
2. Retired member is enrolled in the Retiree Vision Program, and they are the spouse or domestic partner of an active employee, enrolled in the State active vision plan, and they also have a dependent child.
3. Retired member is enrolled in the Retiree Vision Program, and they are the spouse or domestic partner of an active employee (who is also a dependent child on the Retiree Vision plan), enrolled in the State active vision plan.
4. Retired member is enrolled in the Retiree Vision Program, and they are the spouse or domestic partner of an active (non-state) employee, enrolled in a non-state vision plan.
5. Retired member is enrolled in the Retiree Vision Program, and they are the spouse or domestic partner of a retiree, enrolled in a non-state vision plan.
6. Retired member is enrolled in the Retiree Vision Program, and they are the spouse of an active (non-state) employee, enrolled in a non-state vision plan, and they have a dependent child.
 

Coordination of Benefits

 

When an eligible employee or annuitant/retiree has coverage through the State's Vision Program and the spouse or domestic partner has coverage through an employer other than the State of California, the procedure for coordination of benefits will be as follows:

1. When one pair of glasses is obtained from a member doctor, the benefits can be coordinated to pay for the deductible, if any, plus some cosmetic extras. The secondary plan can be utilized to reimburse deductibles and overages, up to the limit of that plan.
2. Two pairs of glasses may be received from a member doctor when the benefits are coordinated. The deductible, if any, will apply to the second pair of glasses. However, the first deductible and some cosmetic extras, will be paid for by the eligible employee or dependent obtaining the glasses. If the patient is eligible for an exam under both benefits, then the secondary exam benefit can be used to pick-up the deductibles and overages from the primary benefit, up to the limit of the secondary exam benefit.
3. When services for one pair of glasses are received from a non-member doctor, VSP will reimburse the patient up to the combined scheduled allowance, not to exceed the actual examination fee and the cost of the materials.
4. An individual may choose to receive glasses and contact lenses from either a member or non-member doctor and the normal deductible and limitations will apply. If only elective contact lenses are selected, the combined schedule of allowances will apply, not to exceed the actual charges.
 
When spouses or domestic partners both have coverage through the State's Vision Program, or the Vision Care Program for State Annuitants, or combination thereof, procedures for coordination of benefits will be as follows:
1. Employee and spouse/domestic partner can receive benefits under each other's plan and receive two pair of glasses subject to the independent deductibles and all other plan limitations.
2. Employee and spouse/domestic partner can use their secondary coverage to cover the cost of extras.
3. If an employee receives only one pair of glasses, the deductible may be paid by the secondary coverage.
4. Dependent children can receive only one pair of glasses under either their parent's plan subject to the deductible and plan limitations when both enrolled person are active employees, and only one pair under either plan unless the child(ren) is/are enrolled as dependents under the annuitant's/retiree's plan as a dependent(s).
When an eligible employee or retiree/annuitant has coverage through the State's Vision Program or Retiree/Annuitant Vision Program and the spouse/domestic partner has coverage through another insurance company, the State's Vision Program or Retiree/Annuitant Vision Program will be the primary coverage unless the request for payment is submitted with a paid statement from the other insurance carrier. The State's carrier will then pay the deductible, if any, and services not covered under the other plan, subject to the carrier's plan provisions and limitations.  

 

1207. Direct Payment Process

An active employee on non-pay status may elect to continue vision coverage by paying the total premium directly to the vision carrier. During the period of non-pay status the State contribution towards the vision premium is not paid, therefore, an employee must be advised that they can elect to continue their vision coverage through direct payment in order to maintain coverage.
 

The Vision Plan Direct Payment Authorization (STD. 703)

The Vision Plan Direct Payment Authorization (STD. 703) is used to enroll eligible employees in Direct Pay. See Attachment D - Vision Plan Direct Payment Authorization (STD. 703) for a copy of the STD. 703 and Section 1212 for completion instructions.
 
An employee who wishes to continue coverage while off pay status must complete a STD. 703 and forward the form directly to the carrier with a check or money order for a full three-month premium amount. The employee's enrollment may not exceed the duration of the State's contract or one year, whichever comes first. However, in the event of an approved extension to the leave of absence, the carrier will accept direct payments beyond the normal one-year period. A newly completed STD. 703 must be completed and submitted to the vision carrier.
 
An employee who does not elect direct payment must complete Part B of the STD. 703, to decline continued coverage. If the employee elects not to enroll he/she will be liable for any vision expenses incurred while off pay status (vision premiums will not be paid by the State during this period). A copy should be retained in the employee's personnel file. In this instance, do not send a copy of the STD. 703 to the vision carrier.
 
Instructions for the completion of the STD. 703 are printed on the reverse side of the form. Personnel staff should verify that all information is completed correctly. Do not forward copies of the STD. 703 to SCO or CalHR.
 

Absences/Situations Where Coverage Lapses

  1. Leave of absence for one or more full pay periods, but other than NDI, IDL, 4800 Time or Workers Compensation with supplementation.
  2. Appeal of involuntary termination. (COBRA provisions apply; direct payment provisions are not applicable).
  3. Suspension of one or more complete pay periods.
  4. Permanent-Intermittent, enrolled but off pay status (Reduction in hours - COBRA provisions apply, direct payment provisions are not applicable).
  5. Application for disability retirement is pending (employee is off pay status).
  6. Pending IDL determination when all sick leave and vacation credits have been exhausted (employee is off pay status).
  7. Death of an employee (120-day death benefit apply, COBRA is applicable after CalPERS' determination of survivor benefits).
  8. Under approved SDI benefits.

 

Direct Payment of Premiums

  1. The vision carrier will not send a monthly bill to an employee who elects to pay premiums directly while he/she is off pay status. Therefore, it is the responsibility of each employee to ensure premium payments are paid timely. Direct pay is normally limited to 12 months. However, in the event of an approved extension to the leave of absence, the carrier will accept direct payments beyond the normal one-year period.
  2. Payments must be paid in advance and cover a minimum period of three months or the length of the absence whichever is less. The employee's check/money order for the first three months must be attached to the newly completed STD. 703 and sent to the carrier.
  3. The vision carrier must receive the initial payment by the first day of the month following the first full month the employee is off pay status. Subsequent installments and/or final payment are due to the vision carrier by the first of each subsequent three-month period. STD. 703 forms received by the vision carrier without the required payment attached will be returned to the employee. Failure to pay the required payment in a timely manner will result in the employee's vision coverage being cancelled.
  4. In the event an employee returns to pay status prior to the end of his/her approved leave of absence, it will be the employee's responsibility to contact the vision carrier to request a refund of any direct premium overpayments paid.

 

Return to Pay Status

Upon return to pay status (if an employee is still enrolled), the State premium contributions will commence with the first pay warrant issued by SCO. 
 

1208. 120-Day Survivor Death Benefit for Continuation of Benefits

Under the 120-day death benefit, departments are required to continue to pay the employer & employee contributions for a covered employee's spouse, domestic partner and/or other eligible family members for up to 120 days following an employee's death.This means if an employee was in the Premier vision plan at the time of death, the department is responsible for paying the full premier premium for 120 days.  The 120-day period is to provide the family a grace period while the California Public Employees' Retirement System (CalPERS) determines if the spouse or other family members are eligible for a survivor's benefit.
 
In implementing this benefit, departments will use the process used for an employee on an unpaid leave of absence (STD. 696). Under this process, the deceased employee's department will pay four months of both the employer and employee contributions directly to the vision carrier.
 
An eligible spouse and/or other eligible dependent(s) who is determined to be an eligible survivor through CalPERS and receives a continuing allowance from CalPERS may continue vision coverage as annuitants.
 
If CalPERS determines that the spouse and/or other eligible family member(s) is not eligible for a continuing allowance, then the department should notify the spouse and/or other eligible family member(s) of COBRA eligibility within sixty days from the date CalPERS makes this determination. Upon notice of COBRA eligibility by the department, it is the responsibility of the spouse or other eligible family member(s) to pay monthly premiums directly to the carrier(s) in the manner prescribed in the COBRA notice.
 
Authority:
Collective bargaining agreements (all twenty-one bargaining units) Legislation enacted - AB 1639, Chapter 926, 1999
Reference:
1. Personnel Management Liaison Memorandum (PML) 99-066
2. DPA Personnel Transaction Supervisors and Personnel Transaction Staff Memorandum dated August 7, 2001
 

1209. Consolidated Omnibus Budget Reconciliation Act (COBRA)

The State does not continue paid vision coverage for employees into retirement. Each department is required to offer retiring employees the option to enroll in the Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) Program. COBRA allows employees and dependents the option to maintain vision benefits for either 18 or 36 months after losing coverage because of certain COBRA qualifying events.
 
Departments are responsible for ensuring that covered employees and their covered dependents are provided with COBRA information, required COBRA notices, and for assisting those employees and dependents that elect to enroll by ensuring all forms are completed and submitted timely.
 
Departments should review the COBRA policy and procedures outlined in the Benefits Administration Manual (BAM) - COBRA Section 400 in the event an employee or dependent has any of the following COBRA qualifying events:
  

COBRA Qualifying Events and Length of Eligibility

  • Voluntary or Involuntary Termination (other than for Gross Misconduct), Reduction of Hours: 18 months
  • Death of Employee, Divorce, Termination of Domestic Partnership, Legal Separation, Employee's Entitlement ot Medicare, or Dependent Child Ceases to be a Dependent: 36 Months
  • Military call-up: 24 Months
 
For a leave of absence, the vision benefits may be continued through Direct Payment, not COBRA. (see Section 1207 for direct payment information) 
 

1210. Instructions for Completion of STD. 700

The STD. 700 can be ordered through the Department of General Services (DGS), Office of State Publishing and also available as fill and print on their web site. The form is also available as fill and print on CalHR web site.
 
1.Section A:
  • A1: Enter employee's Social Security Number
  • A-2: Check appropriate box designating employee's marital status
  • A-3: Check Male or Female
  • A-4: Enter employee's name
  • A-5: Enter employee's mailing address
  • A-6: Enter employee's date of birth
  • A-7: Check appropriate action type
  • A-8: Enter spouse's or domestic partner's name
  • A-9: Enter spouse's or domestic partner's social security number
  • A-10: Enter spouse's or domestic partner's date of birth
  • A-11: Enter family member's name
  • A-12: Enter family member's relationship to employee
  • A-13: Enter family member's social security number
  • A-14: Enter family member's date of birth
(For additional family members, enter information on sections A-15 through A-22)
2. Section B:
  • B-1: Enter name of vision plan being authorized
  • B-2: Enter provider/facility number (if applicable)
3. Section C: For cancellations only
4. Section D: Check one box and Employee's/Retiree's/Annuitant's signature/date required
5. Section E:
  • E-2: Enter 001 for employees not in CoBen. Enter 002 for employees in CoBen.
  • E-4: Enter deduction amount.
  • E-5: Enter State share amount. (N/A for Retiree/Annuitant)
  • E-6: Enter effective date of action.
  • E-7: Enter employee designation. (N/A for Retiree/Annuitant)
  • E-8: Enter employee bargaining unit. (N/A for Retiree/Annuitant)
  • E-9: Enter the total monthly premium.
  • E-10: Enter the date of the permitting event (e.g. new enrollment, PI enrollment, voluntary cancellation). Note: active employees in CoBen may not cancel vision coverage
  • E-11: Enter permitting event code.
  • E-12: Enter agency code. (N/A for Retiree/Annuitant)
  • E-13: Enter unit code. (N/A for Retiree/Annuitant)
  • E-14: Enter agency name.
  • E-16: Check if PI employee.
  • E-17: Signature of authorized agency representative.
  • E-18: Telephone number of authorized agency representative.
  • E-19: Enter date received in Personnel Office.
 
Retain the agency copy (pink copy) in the employee's personnel file and send the original (white copy) to SCO for processing. The goldenrod copy should be sent to the enrollee. (see Section 1214 for address to send the STD. 700).
 

1211. INSTRUCTIONS FOR COMPLETION OF CALHR 774


The CALHR 774  will be available as fill and print on CalHR web site.
The form is available on CalHR web site 
 
1. Complete Section A: Enter the name, social security number, and date of birth, phone number, email and mailing address of the eligible employee.
2. Complete Section B: Enter dependent information including whether dependent is being added or deleted; if there are no dependents, skip Section B and go to Section C.
3. Complete Section C: Check the appropriate box to elect to enroll. Employee must sign and date the bottom of Section C.
4. Complete Section D: This section to be completed by Employing Agency only.
• D-1: Enter the deduction code (N/A if completing new COBRA enrollment for retiring employee)
• D-2: Enter party code (1-member only, 2-member plus one dependent, 3-member plus two or more dependents).
• D-3: Enter premium deduction amount.
• D-4: Enter effective enrollment. (As a Rule: First Day of Second Month)
• D-5: Enter BU/CBID
• D-6: Enter permitting event date.
• D-7: Enter permitting event code 
• D-8: Enter agency name, unit code, and agency code.
• D-9: Enter any remarks
• D-10: Enter agency area code and telephone number.
• D-11: Enter date of agency signature.
• D-12: Enter agency phone number and email. Sign name of authorized agency signature.
• D-13: One copy should be retained in agency file, one copy should go to the employee.

Please mail completed CalHR 774 form to VSP's mailing address or fax to VSP at (916) 463-9031 for processing. See Section 1214 for address to send the CalHR 774.
  

1212. Instructions for Completion of STD. 703

The STD. 703 can be ordered through the Department of General Services (DGS), Office of State Publishing and also available as fill and print on their web site. The form is also available as fill and print on CalHR web site.
 
1. Complete Part A: Enter the name and social security number of the eligible employee).
2. If the employee does not wish to retain vision coverage, then complete Part B. Employee's signature/date required in Part B or C.
3. Part C: Enter payment amounts.
4. Complete Part D as follows:
  • D-10: Enter agency name.
  • D-11: Enter agency address.
  • D-12: Enter employee position number.
  • D-13: Enter reason (e.g., leave of absence, survivor benefits, IDL, awaiting disability determination).
  • D-14: Enter the dates of absence.
  • D-15: Enter pay period of last deduction.
  • D-16: Signature of authorized agency representative.
  • D-17: Telephone number of authorized agency representative.
  • D-18: Enter date received in Personnel Office.
 
Retain the department copy in the employee's personnel file and send the carrier copy to the vision plan (retain the carrier copy, if the employee declines direct payment). The employee copy should be sent to the employee. (see Section 1214 for address to send the STD. 703) 
 

1213. Instructions for Completion of CalHR 695

The form is available on CalHR web site
1. Complete Section A: Enter the name, social security number, and date of birth, and address of the eligible retiree.
2. Complete Section B: Enter dependent information; if there are no dependents, skip Section B and go to Section C.
3. Complete Section C: Check the appropriate box to elect to enroll. Retiree must sign and date the bottom of Section C.
4. Complete Section D: This section to be completed by Employing Agency only.
  • D-1: Enter the deduction code, 475.
  • D-2: Enter party code (1-member only, 2-member plus one dependent, 3-member plus two or more dependents).
  • D-3: Enter premium amount.
  • D-4: Enter effective date of enrollment.
  • D-5: Enter BU/CBID at retirement.
  • D-6: Enter permitting event date.
  • D-7: Permitting Event Code is standard and already input (50).
  • D-8: Enter agency name, unit code, and agency code.
  • D-9: Enter any remarks. Enter the separation date and the retirement date.
  • D-10: Enter agency area code and telephone number.
  • D-11: Enter date of agency signature.
  • D-12: Sign name of authorized agency signature.
  • D-13: One copy should be retained in agency file, one copy should go to the retiree/annuitant, and one copy should be sent to the vision plan.

 

Please mail completed CalHR 695 form to VSP's mailing address or fax to VSP at (916) 463-9031 for processing. See Section 1214 for address to send the CalHR 695.

  

1214. Vision Plan Premiums, DEDUCTION CODES and Plan Addresses

Deduction Codes:

 

Basic Vision Plan

475-001 (Non-CoBen)
475-002 (CoBen)
 

Premier Vision Plan

361-475 
 

Basic Vision Plan Premiums

1 Party: $8.64
2 Party: $8.64
3 Party: $8.64
 

Premier Vision Plan Premiums

 

Monthly Premier Vision Plan premiums, including employer/employee shares:

           Employer Share        Employee Share     Total Premiums
1 Party:       $8.64                      $6.56                    $15.20
2 Party:       $8.64                      $13.12                  $21.76
3 Party:       $8.64                      $21.12                  $29.76
 

The COBRA Premium - Basic Vision Plan

1 Party:       $8.81
2 Party:       $8.81
3 Party:       $8.81
 

The COBRA Premium - Premier Vision Plan

1 Party:      $15.50
2 Party:      $22.20
3 Party:      $30.36
 

Retiree/Annuitant Premium

1 Party:      $7.53
2 Party:      $14.62
3 Party:      $15.73
 

Vision Plan                           [Physical Address]

Vision Service Plan (VSP)
3333 Quality Drive
Rancho Cordova, CA 95670
1-800-877-7195
 

Vision Plan Web Site

At the VSP web site, click the Members & Consumers box. The prompt will then take you to the log-in page.
This site can also be accessed through the CalHR web site.
 

Direct Payment and COBRA enrollments, send forms and payments to:


Vision Service Plan (VSP)
P.O. Box 997100
Sacramento, CA 95899-7100
FAX: 916-463-9031
 

Premier/Annuitant/Retiree Enrollments and Direct Bill payments send to:


Vision Service Plan (VSP)             [Mailing Address]
Attn: Client Services MS 229
P.O. Box 997100
Sacramento, CA 95899-7100
FAX: 916-463-9031 
 
APPEALS

Please ONLY send vision enrollment appeals to:

 
Department of Human Resources (CalHR)
Benefits Division
1515 "S" Street, N-400
Sacramento, CA  95811-7258
Attention: LaTrice Moore
 
or
 
Fax Vision Appeals to LaTrice Moore at (916) 322-3769

Updated 7/8/2014