Vision Service Plan—Small & Large Groups

Vision Service Plan offers multiple vision plans for businesses with 2 to 1,000 employees. A $15 administrative fee is charged each month to all VSP groups.*

Enrollment Forms:

Please be advised that CoPower has discontinued the use of the Remittance Report and has replaced it with the following forms, effective immediately:

• VSP Individual Application
• VSP Enrollment/Change Form
  (for additions/changes to CoPower’s VSP policies)
• Termination Form
  (for terminations from any of CoPower’s policies)

For more information, please read our Notice to CoPower groups regarding these changes.

• VSP Waiver Form

Brochures:

Signature Plans:

PPO:

• Signature Plan A $25
• Signature Plan B $25
• Signature Plan C $10

Voluntary:

• Voluntary Signature Plan B $10
• Voluntary Signature Plan C $10

Choice Plans:

PPO:

• Choice Plan A $20
• Choice Plan A $25/$25

Voluntary:

• Voluntary Choice Plan B $20/$20

General Information:

• Using VSP
• VSP Member Card
• FAQs
• VSP Out-Of-Network Reimbursement Form
• VSP Grievance System

CoPower Information:

Third Party Administration Details:

• Maintaining Your Vision Plan
• Important Notice to CoPower Groups
• New Hires, Additions & Terminations and COBRA Employees
• When to Use Your CoPower ID & Group Claim Number

Manuals:

• Vision Service Plan Manual (for Voluntary Plans)
• Vision Service Plan Manual (for Non-Voluntary Plans)