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We’re here to answer your questions

Coverage can be complicated. We get that. That’s why we’re providing answers to the most commonly asked questions.

General Member Information  
Member ID Number  

You will need your member ID number to log in to the VBA Member Portal and to schedule an appointment with your in-network provider.

  • In most cases, your member ID is the last four digits of the policyholder's SSN.
  • Occasionally, your member ID may be a unique number assigned and provided to you by your employer.
  • If a member would like a VBA Member ID Card, custom cards are available for the member to print one from the VBA Member Portal.
Member ID Cards  

VBA has simplified the process. You do not need an ID card to make an appointment or visit your in-network provider.

  • An ID card is not needed to receive services or materials from an in-network provider.
  • When making your appointment, tell your in-network provider you have coverage through VBA.
  • You will need to provide your VBA Member ID Number to your VBA in-network provider.
  • If you would like a VBA Member ID Card, you can print one from the VBA Member Portal.
My Information  

VBA receives member name, address and date of birth from the employer.

  • If your information is incorrect, please contact the employer's benefits administrator or human resources department.
  • All changes to your information must be made by the employer's benefits administrator or human resources department.
Claims and Benefits  
Bill from Doctor  

There are certain instances where your provider may bill you for materials and services.

  • The provider was not aware you have VBA.
  • Your provider was not a VBA in-network provider.
  • The provider billed your medical benefits instead of VBA.
  • There were out-of-pocket expenses for services or materials not covered by your benefits.

For more information regarding a bill from your provider's office, please reach out to your provider or contact us.

Submitting a Claim  

You will need to let your VBA in-network provider know you have VBA prior to receiving services or purchasing materials.

Type of Provider How to Submit a Claim
VBA in-network provider
  • Log in to the VBA Member Portal to confirm eligibility for services and materials.
  • Use our online Provider Finder to search for doctors in the VBA network.
  • Schedule an appointment with the provider and let the office know you have vision benefit coverage through VBA prior to receiving services or purchasing materials.
  • The provider will submit all claims for covered benefits directly to VBA. 
  • The provider will discuss and collect any copayments and/or out-of-pocket expenses from you, if applicable. 
Out-of-network provider
  • Log in to the VBA Member Portal to confirm eligibility for services and materials and to confirm your plan offers out-of-network benefits.
  • If your plan offers out-of-network coverage and you were eligible for benefits on the date of service, you may submit a claim to VBA for reimbursement.
  • You will need to submit an Out-of-Network claim form.
Not Sure
  • Contact us if you are unsure about the provider you selected. Our Member Services team can help by explaining your coverage, checking if the provider is in-network and checking your eligibility status before scheduling your appointment.
Submitting an Out-of-Network Claim  

If your plan offers out-of-network coverage and you were eligible for benefits on the date of service, you may submit a claim to VBA for partial reimbursement.

Step Details
1. Getting started
  • Confirm eligibility for out-of-network benefits by accessing the Member Information tab of the VBA Member Portal, or by contacting us.
2. What you'll need
  • To submit a claim, you will need to provide us with a copy of your itemized receipts or service statements with the following information:
    • Provider's name;
    • Patient's name;
    • Date of service;
    • Services and/or materials received;
    • Amounts paid.
  • Once you have collected the above documents, use the information to complete VBA's Out-of-Network form.
3. How to submit
  • After completing and signing the Out-Of-Network form, you may mail or fax your claim with copies of your itemized receipts to:
    • VBA 400 Lydia Street, Suite 300 Carnegie, PA 15106
    • 412-881-4898 (Facsimile)
  • Go Green! For faster processing, you can now submit your claim to VBA electronically. Simply use VBA’s member login with the policy holder’s information, and select “Out-of-Network Claims.” From there, follow the prompts to upload images of your signed forms and receipts.
4. Processing your claim
  • Please allow up to 15 business days (after receipt) for VBA to process your reimbursement claim.
Possible Reasons an Out-of-Network Claim May Be Denied  

It is important to make sure your plan offers out-of-network benefits prior to receiving services or purchasing materials. Some plans do not offer out-of-network benefits. Please check your network benefits by logging into the VBA Member Portal or contacting us

Out-of-Network claims must be submitted within one year of the date of service.

Out-Of-Network claims may be denied if:

  • The policyholder’s plan was not active on the date of service.
  • The patient was not eligible for services on the date reflected on the receipt(s).
  • The address on the form is different from VBA records.
  • The form was submitted to VBA beyond the Out-Of-Network claim filing deadline.
  • Other

Please contact VBA Member Services if you have questions regarding your out-of-network claim denial. 

Explanation of Benefits  

You may review EOBs for you or other covered family members by accessing the Explanation of Benefits tab of the VBA Member Portal.

Providers  
Find an In-Network Provider  

Using a VBA in-network provider makes using your benefits easier.

  • Use the VBA Provider Finder available at vbaplans.com to locate a provider near you.
  • Contact us. One of our Member Services Representatives will help you find a provider near you.
  • When you call to make an appointment with a VBA in-network provider, tell them you have VBA. On rare occasions, a provider may no longer accept VBA at the time of your appointment. Be sure to confirm network participation with your provider prior to receiving services or purchasing materials.

When you call to make an appointment with a VBA in-network provider, tell them you have VBA. On rare occasions, a provider may discontinue participation in our network without proper notice. When making your appointment, please verify participation to avoid any inconvenience.

Log in to the VBA Member Portal or contact us to make sure you are eligible to receive services.

On rare occasions, a provider may discontinue participation in our network without proper notice. When making your appointment, please verify participation to avoid any inconvenience.

VBA In-Network Providers  

Select a VBA In-Network Provider to use your benefits.

  • Log in to the VBA Member Portal to confirm eligibility for services and materials.
  • Use our online Provider Finder to search for doctors in the VBA network.
  • Schedule an appointment with the provider and let the office know you have vision benefit coverage through VBA prior to receiving services or purchasing materials.
  • The provider will submit all claims for covered benefits directly to VBA.
  • The provider will discuss and collect any copayments and/or out-of-pocket expenses from you, if applicable

On rare occasions, a provider may discontinue participation in our network without proper notice. When making your appointment, please verify participation to avoid any inconvenience

My Provider is Out-of-Network  

If your plan offers out-of-network coverage and you are eligible for benefits, you may elect to visit an out-of-network provider.

VBA adds new providers each day. If you would like your provider to be added to the network, complete the Refer a Provider form, and our team will reach out to see if the provider is interested in joining.

Coverage  
Service and Material Frequencies  

The company who contracted for your benefits (typically the policyholder's employer) determines the frequency of coverage for services and/or materials.

Log in to the VBA Member Portal or contact us to review your plan frequency for:

  • Routine vision exam
  • Frames
  • Lenses or contact lenses (routine vision exam, contact lens fit and contact lens materials are in lieu of all other benefits for most plans)

The contracting company is also able to select either a 12-month frequency or a 24-month frequency for benefits based on Last Date of Service or Calendar Year.

Last Date of Service coverage begins once you first receive services or materials.

  • This Date of Service determines when you will next be eligible to utilize benefits.
  • Upon the expiration of your 12-month or 24-month waiting period, you will remain eligible until you utilize your benefits for services and/or materials (or are no longer a covered insured).

Calendar Year coverage begins on the first day of the month selected by the company and renews on the same day 12 or 24 months later, unless the policy has expired or is terminated.

  • Coverage may begin in any month selected by the company for eligible, enrolled members.
  • Benefits will be available until you receive services and/or materials during the applicable 12-month or 24-month benefit cycle.
  • After the applicable 12 or 24 month period expires, a new benefits cycle begins  and you will again be eligible for services and materials.
  • Unused benefits from one benefit cycle cannot be carried over to another.
Elective Contact Lenses  

It is important to make sure your plan offers elective contact lens benefits prior to purchasing materials. Log in to the VBA Member Portal or contact us to make sure you are eligible for contact lenses prior to making an appointment with your provider.

Plan Type Details
Total Allowance
  • Your Contact Lens allowance may be used for:
    • Routine vision exam and/or
    • contact lens fit/evaluation fee and/or
    • contact lens materials
  • Exam fees, fitting fees and contact lens materials may vary by provider.
  • Ask your VBA in-network provider about all fees prior to making an appointment.
  • If your plan offers contact lens benefits and you are eligible to receive services and purchase materials, your contact lens allowance may be applied to the contact lens exam, contact lens fit and/or contact lens materials. You will be responsible for any charges that exceed the allowance.
Exam Plus
  • Your Contact Lens allowance may be used for:
    • contact lens fit and/or
    • contact lens materials
  • If eligible, your contact lens exam is excluded from your contact lens allowance.
  • Fitting fees and contact lens materials may vary by provider.
  • Ask your VBA in-network provider about all fees prior to making an appointment.
  • If your plan offers contact lens benefits and you are eligible to receive services and purchase materials, your contact lens allowance may be applied to the contact lens fit and/or contact lens materials. You will be responsible for any charges that exceed the allowance.

Elective contact lenses are typically in lieu of all other services and materials.

The company who contracted for your benefits determines the Contact Lens Allowance (if applicable) for your plan.  Any charges that exceed the amount of your allowance will be your responsibility and you may be required to pay contact fitting fees out of pocket at some locations. 

Contact Lens Fit  

The contact lens exam and fit varies from a routine eye exam.

A contact lens fit is an evaluation that is conducted in addition to your routine eye exam. The purpose of the contact lens fit is to ensure proper fit of your contact lenses and to assess your vision wearing contact lenses.

Contact lens fittings allow your provider to evaluate you for potential risk factors that may cause eye conditions from improper contact lens fit. For first time wearers or wearers choosing a new lens, your provider may provide you with training and education on how to properly care for and wear your new lenses.

Contact lens fitting fees vary by provider. Ask your VBA in-network provider about all fees prior to making an appointment.

Frame Selection  

Log in to the VBA Member Portal or contact us to make sure you are eligible to purchase frames prior to making an appointment with a VBA in-network provider.

VBA offers a wholesale allowance so you may pick frames that make you comfortable and fit your lifestyle.

VBA does not limit you to certain manufacturers or styles. Instead, your plan has an allowance based on the wholesale cost of frames determined by the company providing your coverage (typically the policyholder's employer). If you choose frames above the plan's allowance, the provider will charge you a fee. Ask your VBA in-network provider for help choosing stylish frames within your budget.

The frame allowance is based on wholesale pricing at non-retail locations.  Frame allowance and frame selection policies vary by location.  Providers and frame manufacturers may limit certain frame selections.  Contact your provider before requesting services.

VBA does not offer frame, lens, or contact lens exchanges.

If you are unhappy with your selection or have any issues with products or services purchased from a VBA in-network provider or out-of-network provider, please contact your provider.

Using Your Benefits  

Using your in-network benefits is simple.

  • Log in to the VBA Member Portal to confirm eligibility for services and materials.
  • Use our online Provider Finder to search for doctors in the VBA network.
  • Schedule an appointment with the provider and let the office know you have vision benefit coverage through VBA prior to receiving services or purchasing materials.
  • The provider will submit all claims for covered benefits directly to VBA.
  • The provider will discuss and collect any copayments and/or out-of-pocket expenses from you, if applicable.

On rare occasions, a provider may discontinue participation in our network without proper notice. When making your appointment, please verify participation to avoid any inconvenience.

Copays  

Any applicable copays must be paid at the time you receive services or purchase materials from a VBA in-network provider.

Log in to the VBA Member Portal or contact us to make sure you are eligible to receive services or purchase materials prior to making an appointment. The VBA Member Portal contains information regarding applicable copayments.

Routine, Comprehensive Vision Exam  

Many VBA plans include a routine vision exam.

Log in to the VBA Member Portal or contact us to make sure you are eligible for an exam prior to making an appointment with a VBA in-network provider.

Medical Eye Exam vs. Routine, Comprehensive Vision Exam  

Your provider may ask for your medical insurance ID card prior to receiving services. The provider will make a professional determination, based upon eye conditions and overall health conditions detected or monitored during the eye exam, to bill your medical coverage. Examples of reasons your provider may bill your medical coverage over routine vision coverage may include (but are not limited to) diabetes, keratoconus, post cataract surgery, dry eye, glaucoma, etc.

For more information regarding your provider billing your eye exam to your medical coverage, please contact your provider.

 

Lenses and Lens Enhancements  

Log in to the VBA Member Portal or contact us to make sure you are eligible to purchase lenses prior to making an appointment with a VBA in-network provider.

Under most plans, eyeglass lenses are covered or discounted when visiting a VBA in-network provider for eligible members. In some cases, additional lens treatments or materials are covered or discounted.

Dependent upon your coverage and eligibility, you may incur out-of-pocket expenses for lens enhancements such as:

  • Anti-reflective coatings
  • Blue light materials and/or coatings
  • UV protection
  • Progressive lenses
  • Tinted lenses
  • Photochromic lenses
  • Mirror lenses, etc.

The company who contracted for your benefits determines coverage for lens enhancements. Log in to the VBA Member Portal or contact us to learn more about covered and non-covered lens enhancements.

Warranties, Guarantees and Exchanges  

Your VBA coverage does not include warranties, guarantees or exchanges unless provided by your VBA in-network provider or the manufacturer.

VBA does not offer warranties on lens materials or lens enhancements. VBA does not offer replacements to broken or lost frames, lenses or contact lenses.

VBA does not guarantee any materials or services purchased from or provided to you by your VBA in-network provider or from your out-of-network provider.

VBA does not offer frame, lens or contact lens exchanges.

If you are unhappy with your selection or have any issues with products or services purchased from a VBA in-network provider or out-of-network provider, please contact your provider.