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General Claims and Disability Forms
VSP Vision Benefits Information – This notice describes the PWGA’s new Vision Benefit administered and insured by VSP effective July 1, 2017. VSP is a nationwide network of eye care and eyewear providers. All eligible participants (excluding participants covered under the Low Option Plan) will automatically be enrolled in the new VSP vision program.
VSP Vision Claim Form/Non-Traditional Providers – This form is needed to submit Vision claims for services rendered by non-network VSP providers on or after 7/1/2017. Claims must be filed with VSP no later than 12-months after the date of service.