Vision Service Plan—Large & Small 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.*

Forms and Applications:

New Group Enrollment Forms:

• VSP New Group Submission Checklist
• Employer Application for Dental and Vision
• VSP Application Census
• VSP Waiver Form

Inforce Group Enrollment Applications:

• VSP Individual Application
• VSP Enrollment/Change Form

Reimbursement Form:

• VSP Out-Of-Network Reimbursement Form