VISION BENEFITS ARE NOT PROVIDED FOR RETIREES AND THEIR SPOUSES
Payment of Vision Benefits
If a covered person incurs covered vision expenses, benefits will be payable at 80% (100% for children under 26) up to a maximum of $500 per calendar year.
To be considered “covered vision expenses,” charg-es for services and supplies must be provided by an optometrist or an ophthalmologist who is legally qualified and licensed to practice his trade or profession by the appropriate governmental authority and who is performing services within the scope of his specialty.
Covered Vision Expenses
Covered vision expenses include the reasonable and customary charges made for the following:
- Examination – Complete visual analysis, including case history and refraction, and the prescription of eyeglasses where indicated. Vision benefits are payable only when eye refraction is performed.
- Lenses – Prescription eyeglass lenses, including but not limited to single vision lenses, bifocal, and trifocal lenses. Covered expenses include lens enhancements such as progressive lenses, polarized or tinted lenses, high-index plastic lenses, aniseikonic lenses, and scratch-resistant and non-reflective coatings, but only when added to prescription lenses.
- Frame – Frames for prescription lenses.
- Contact Lenses – Hard, soft, long-wearing, or disposable prescription contact lenses.
Vision Benefit Exclusions and Limitations
- Supplies that were ordered while a person was not covered under this Plan.
- Services or supplies for which benefits are payable under the Comprehensive Medical Benefit or for medical or surgical treatment.
- Special procedures, such as orthoptics or vision training and Lasik surgery.
- Any eye examination required by: (a) by an employer as a condition of employment which the employer is required to provide under the terms of a labor agreement; or (b) by a government body.
- Charges in excess of the maximum benefit stated on the Schedule of Benefits.
- Any services, supplies or types of treatment for which no benefits are payable under the Plan as a whole as stated in the “What the Plan Does Not Cover” section.