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 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 and/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 the web site at www.eyemedvisioncare.com.
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Vision Care Services
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In-Network Member Cost
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Out-of-Network
Reimbursement
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Exam with Dilation as Necessary
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$0 Copay
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Up to $50
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Frames, Lens & Options Package
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$425 Allowance for frame, lens and lens options; 20% off balance over $425
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Up to $250
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(Any frame, lens and lens options available at provider location.)
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Contact Lenses - Declining Balance*
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Conventional
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$0 Copay, $255 allowance; 15% off balance over $255
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Up to $250
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Disposable
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$0 Copay, $255 allowance; plus balance over $255
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Up to $250
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Medically Necessary
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$0 Copay, Paid-in-Full
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Up to $250
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Laser Vision Correction
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Lasik or PRK from U.S. Laser Network
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15% off retail price or 5% off promotional price
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N/A
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Additional Pairs Benefit:
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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.
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N/A
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Frequency:
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Examination
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Members < 19 Years of Age (Once Every 12 Months)
Members > + = 19 Years of Age (Once every 24 months)
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Frame & Lenses or Contact Lenses
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Once every 24 months – Any Age
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* 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.