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Click ‘Get Form’ to open the vsp enrollment form PDF in the editor.
Begin by entering your group name (employer) at the top of the form. This identifies your employer's plan.
Fill in your personal details, including your last name, first name, and middle initial. Ensure accuracy for proper identification.
Provide your Social Security Number and select your gender from the options provided.
Enter your date of birth in the specified format (month/date/year) and indicate the effective date of coverage.
Choose the type of coverage you are selecting by marking one of the options: employee only, employee and one dependent, employee and child(ren), employee and family, or waive coverage.
For dependents, fill out their last name, first name, gender, relationship type (S, C, H, T), and date of birth for each dependent you wish to enroll.
Finally, sign the form at the bottom to confirm that all information is accurate before submission.
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Creating your VSP Member Account is easy! On vsp.com, click Create an Account. Enter the required information. Click Create an Account. Youll receive a code along with instructions to finish setting up your account. Once your account is set up, youll receive a confirmation email.
How do I get VSP insurance?
Heres how you can get VSP vision coverage. Through your employerFind out if VSP is offered through your work. Purchase a VSP Individual Vision PlanIf you dont have access to a VSP vision plan through an employer, you can enroll in VSP on your own.
How to enroll in VSP?
Enroll through your employer. Ask your employer if they offer a VSP vision plan or if they offer a plan when you retire. Enroll during your open enrollment and during any qualifying life events (marriage, baby, job change, etc.). Enroll in a plan you can buy on your own.
How to share VSP with someone?
If youd like to include your spouse or family members, please choose a two-person or Family Plan when you enroll. You can also buy an individual plan for a friend or family member who doesnt have vision coverage.
How to become a VSP member?
There are a few different ways to become a VSP member: Enroll through your employer. Enroll in a plan you can buy on your own. Enroll in VSP through an Exchange or Marketplace. Eligible federal employees, annuitants, and those eligible for TRICARE can enroll in VSP Vision Care during open season.
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People also ask
What is my member ID for VSP?
When you schedule an eye appointment, your doctor may ask for your VSP member ID or member number. This may be the last four digits of your (the primary subscribers) social security number or a unique ID given by your employer (if you are enrolled through your workplace).
vsp enrollment
Enrollment Form with Dependent Data
Name of group (employer):. Employee last name, first name, middle initial: Social Security Number: Employee Home Address: Email Address:.
VSP Enrollment Form for University of California Retirees
I understand that VSP will bill me directly for my vision coverage. Based on the payment option I have selected, I authorize VSP to automatically debit my
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