Your session is about to expire due to inactivity.

Vision Forms

    General Claims and Disability Forms

    Vision Claims
  • 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.