Optical Benefits
(Employees and Dependents)

To help you with vision care, the Fund pays Optical Benefits up to the maximum amount shown in the Schedule of Benefits during a consecutive two-year period for the following:

See the Schedule of Benefits for the amount of optical benefits provided by the Plan.

• Professional examination by an ophthalmologist (MD) or optometrist;
  
  
• Lenses prescribed by an ophthalmologist (MD) or a licensed optometrist, including prescription sunglasses, transitional lenses, tinted lenses, contact lenses and safety glasses; and
  
  
• Frames purchased in conjunction with lenses newly prescribed by an ophthalmologist (MD) or a licensed optometrist.
  

Call EyeMed Vision Care at 1-866-723-0514 for help finding a network provider or access the web site at http://portal.eyemedvisioncare.com/wps/portal/emweb

Effective January 1, 2011 the Trustees have contracted with an optical PPO, EyeMed Vision Care, that provides first dollar benefits up to the maximum in the Schedule of Benefits. Because EyeMed provides discounts for eye examinations, lenses and frames, your benefit amount will go further. You do not have to submit a vision claim form, but you will be required to pay the EyeMed Provider for any cost over your maximum when you pick up your glasses or contact lenses. The benefits provided by EyeMed Vision Care are summarized as follows, subject to all terms and conditions of the EyeMed Vision Care program which are subject to change. Additional discounts and exclusions apply. Contact EyeMed for details.

Vision Care Services	Member Cost	Out-of-Network
Exam with Dilation as Necessary	$0 Copay	Up to $45
Frames, Lens & Options Package (Any frame, lens and lens options available at provider location.)	$300 Allowance for frame, lens and lens options; 20% off balance over $300	Up to $180
Contact Lenses - Declining Balance* Conventional Disposalbe Medically Necessary	$0 Copay, $180 allowance, 15% off balance over $180 $0 Copay, $180 allowance; plus balance over $180 $0 Copay, Paid-In-Full	Up to $180 Up to $180 Up to $180
Laser Vision Correction Lasik or PRK from U.S. Laser Network	15% off retail price or 5% off promotional price	N/A
requency: Examination Frame & Lenses or Contact Lenses	Once every 24 months Once every 24 months

* If you use an out-of-network Provider, you are required to pay the entire cost up-front to the Provider. You must submit a vision claim form to EyeMed. EyeMed will process the claim and remit payment, up to the applicable maximum, directly to you.

In addition to the exclusions listed in the General Exclusions and Limitations, the Fund will not pay optical benefits for routine yearly examinations required by an employer in connection with your occupation.