Who is eligible
Members and eligible dependents, as defined by the Fund, are entitled to an optical benefit ONCE every calendar year.
What is the Benefit
As of 1/1/2021 the Fund will pay up to $100 per eligible person for specified optical services provided by any licensed optometrist, optician or physician* of your choice in accordance with the fee schedule. Prior to 1/1/2021 the fee was up to $80 per eligible person. The fee schedule provides for a maximum allowable amount for each service, which may be claimed once in a calendar year.
*Examinations provided by a physician must first be submitted to your health carrier and a copy of payment or non-payment made must be submitted to the Fund with the claim.
How to receive the benefit
If you are using a participating optical center, an optical voucher must be obtained from the Fund prior to receiving optical services. Allow a minimum of 10 days prior to your appointment for receipt of your voucher from the Fund. Submit the original voucher directly to the provider of services if you utilize a participating optical center.
If you are using a provider of your choice, send your completed original voucher along with an itemized bill (and statement from health carrier if exam was provided by a physician) to the Fund. Photocopies (including faxes) of vouchers are not accepted by the Fund. Reimbursement will be made to you directly.
Exclusions: Non-prescription glasses/sunglasses and VDT glasses
|Participating Optical Program (as of 1/1/2021)
The optical allowance of up to $100 every calendar year may be used at a Participating Optical Center selected by the Fund. The Centers agree to provide the following minimum services for the allowance:
The participating Fund optical providers have also agreed to the following set fees, which are the patient’s responsibility:
MEMBER PAYMENT/SURCHARGES (as of 1/1/2021)
(Fees payable by the patient/member)
These charges are separate and are not to be construed as included in any other covered service or inclusive in another surcharge. Frames selected outside the plan frames will have a $155 allowance subtracted from the retail value of the frame.
|Progressive (Varilux or equal)||$75.00|
|Ultra Thin Lenses (Hi-Index 1.56 or 1.60)||$55.00|
|Progressive Photosensitive Lenses (Generic or Equivalent)||$80.00|
|Contacts, Disposable*||Balance after $100 Fund Payment|
|Sunsensitized Plastic Single Vision Lenses (including transitions)||$40.00|
|Sunsensitized Plastic Bifocal Lenses (Flat Top 28) including transitions||$50.00|
* You may not be denied your choice of disposable contact lenses if you choose not to agree to purchase further disposable lenses from the participating provider or the provider’s recommended disposable lens supplier.
|FUND PAYMENTS (as of 1/1/2021)|
|With or Without Exam, Prescription Lenses and Frames*||$100|
|With or Without Exam, Standard Daily Wear Contacts||$100|
|With or Without Exam, Standard Extended Wear Contacts||$100|
|* If the patient has exhausted the exam portion of their annual optical benefit, the reimbursement will be limited to $70.|