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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:

  • 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.
Professional examination for pediatric preventive care and screenings by an ophthalmologist (MD) or optometrist for children up to age 19 is covered, without limitations.
 

You are not required to pay a deductible or copayment before the Fund pays optical/vision benefits.

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 Vision Care at 1-866-723-0514 for help finding a network  provider or access to the website at www.eyemedvisioncare.com.

Vision Care Services

In-Network Member Cost

Out-of-Network

Reimbursement

 

Exam with Dilation as Necessary

$0 Copay

Up to $50

 

Frames, Lens & Options Package

$425 Allowance for frame, lens and lens options;
20% off balance over $425

Up to $250

 

(Any frame, lens and lens options available at provider location.)

 

Contact Lenses - Declining Balance*

 

 

 
       

Conventional

$0 Copay, $255 allowance; 15% off balance over $255

Up to $250

 

Disposable

$0 Copay, $255 allowance; plus balance over $255

Up to $250

 

Medically Necessary

$0 Copay, Paid-in-Full

Up to $250

 

Laser Vision Correction

 

 

 

Lasik or PRK from U.S. Laser Network

15% off retail price or 5% off promotional price

N/A

 

Additional Pairs Benefit:

Members also receive a 40% discount off complete pair eyeglass purchases and a 15% discount off conventional contact lenses once the funded benefit has been used.

           N/A

 
 

Frequency:

 

 

 

Examination

Members < 19 Years of Age (Once Every 12 Months)

Members > + = 19 Years of Age (Once Every 24 Months)

 

 

Frame & Lenses or Contact Lenses

Once every 24 months – Any Age

 

 

*  Any remaining balance may be used within the same Benefit Frequency. Where the Insured Person previously utilized an In-Network Provider, the remaining balance must be used with the same or any other In-Network Provider. Where the Insured Person previously utilized an Out-of-Network Provider, the remaining balance must be used with the same or any other Out-of-Network Provider.

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.