Enrollment Kit - VSP (Vision)
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This checklist is provided as a guide. The carrier may require additional items and documentation. Please refer to the carrier’s underwriting guidelines for a complete list of requirements. Please use the latest version of forms.
Our goal is to process your new enrollment easily and efficiently in order to provide you and your client with a quick approval. The following list outlines VSP's case submission requirements.
- No binder check is needed. VSP will bill for the first month's premium.
- Employee Roster Sheet (Census enrollment).
- Employee Roster Sheet 3 Tier (for plans quoted by Word & Brown)
- Employee Roster Sheet 4 Tier (for plans NOT quoted by Word & Brown)
- VSP Client Application - please advise the correct rating option, based on the following carrier guidelines:
- Core Rates - 75%-100% employer paid for all. OR, if employer contribution is less than 75% for all, the plan must be bundled with another benefit on a joint enrollment basis - all employees and dependents on the group medical plan or the group dental plan enroll in VSP. Minimum group size of 5 enrolled employees.
- Voluntary Rates - Minimum group size of 10 enrolled employees.
Plan can be 100% employee paid. Changes to enrollment status can be made during the client's annual open enrollment only.
- Core Employee/Voluntary Dependent Rates - 75%-100% employer paid for all eligible employees. Dependent coverage is voluntary and paid for by the employee. Minimum group size of 10 enrolled employees. Changes to enrollment status can be made during the client's annual open enrollment only.
- Core Rates - 75%-100% employer paid for all. OR, if employer contribution is less than 75% for all, the plan must be bundled with another benefit on a joint enrollment basis - all employees and dependents on the group medical plan or the group dental plan enroll in VSP. Minimum group size of 5 enrolled employees.
Licensing: Broker appointment must be completed online via this link. NOTE: The group will not be approved until licensing is received.
| After approval, prior carrier termination letter must be submitted by the employer or broker. |
For other useful or older documents, please refer to the Forms database.