VSP Video Display Terminal (VDT) Claim Form

Format: 
PDF

The VSP Video Display Terminal (VDT) Confirmation Form is only provided to CSU employees who meet the necessary job requirements as determined by the CSU campus benefits office. This form must be completed by the employee and provided to a VSP Select Network doctor to receive the supplemental VDT benefit.

Please call VSP Member Services at 800-877-7195 if you have questions about the benefit.

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