Obtaining a Benefit Form

If eligible, you will receive immediate confirmation that your precertified VBA Benefit Form will be mailed to your home by the end of the next business day. You will also receive the most recent list of VBA participating Providers in your area.

VBA also provides an Automated Phone Request System for your use. By calling 1-800-432-4966 any time, day or night, you will be guided through this fast and easy process. When using the Phone Request System, you will need to know the Member’s ID Number and the birth dates for any family members for whom you are requesting service. Once again, you will receive immediate confirmation of your eligibility and any Benefit Forms issued.

The following instructions should assist you in the proper use of the VBA Benefit Form:

  1. THE VBA BENEFIT FORM CAN ONLY BE USED BY THE PERSON WHOSE NAME APPEARS ON THE TOP OF THE FORM UNDER THE PATIENT HEADING. To determine this, you will have to open the form by tearing back the front address sheet. Then, verify that the information is correct. If not correct, return the form to Vision Benefits of America or the Fund or Company office that issued it. A new form will be issued for the correct person. DO NOT ALTER THIS FORM.
  2. Select a provider from the enclosed list of Participating Doctors (PARTICIPATING PROVIDER LIST INCLUDED INSIDE EVERY FORM). Make your appointment and present this form on your first visit. Please keep your appointment.
  3. If you choose patient options: (e.g. coatings, progressive lenses) which are beyond the scope of your plan’s coverage, YOU ARE REQUIRED TO PAY THE PROVIDER THE ADDITIONAL COST.
  4. If you do not use a VBA Participating Provider, and are eligible for out-of-network benefits, fill in the information on the back of the VBA Copy (Part 1) and submit it along with your itemized receipts that indicate…
    • Exam amount paid
    • Lens type and amount paid
    • Frame amount paid

    Failure to provide this information could result in delayed or incorrect payment. Mail the completed VBA copy and your receipts to:

    300 Weyman Road,
    Suite 400 Pittsburgh,
    PA 15236-1588
    Attn: Non-Panel Claims

  5. SERVICE MUST BEGIN BEFORE THE FORM’S EXPIRATION DATE (generally 90 days from the date of issue). If you do not use your form prior to the expiration date, please return to Vision Benefits of America and check the box provided if requesting a new form.
  6. For VBA Customer Service, you may call 800-432-4966 or 412-881-5521 between the hours of 8:30 am and 7:00 pm Eastern Standard Time, Monday through Friday.