|
ELIGIBILITY
Optical benefits are provided once every 12 months for active and Cobra or Continuation of Benefits member’s and their eligible dependents.
*See the retiree benefits “no cost” plan for frequency of limitation.
THE BENEFIT
The benefit is provided to cover the cost of an eye examination and prescription eyewear by a qualified optometrist. Eligible individuals have the choice of using a participating provider or an optician of their choice. Davis Vision is now administering the Fund’s optical benefit program.
1. Participating Provider Program
Call Davis Vision at 1(800)999-5431 or visit their website www.davisvision.com to verify eligibility and to find a network provider. The benefit will be provided with no out-of-pocket expense if the frame is chosen from the “Tower Collection” if you choose another selection you will receive the current allowance toward a network provider’s own frame. Contact lenses can be selected in lieu of glasses. Standard, soft, and daily-wear types, are available for most prescriptions or the current allowance will be applied toward contact lenses from the network provider’s own supply. *Disposable contacts require a $10.00 co-payment.
Optional lens types or coatings are available for a co-payment at a participating provider. Optional items are polycarbonates lenses, standard anti-reflective coating, high-index lenses, premium progressive lenses, polarized lenses, and plastic photosensitive lenses.
2. Non-Participating Optician
How to receive the benefit:
Select an optical center of your choice, obtain a claim form from Davis Vision, and submit the completed claim form to Davis Vision for reimbursement up to the current allowance toward the eye exam and eyewear. To obtain the claim form, please call Davis Vision at 1(888)999-5431 or print the form from the website www.davisvision.com. To access member information from the Davis Vision website members must obtain a username and password by following the prompts.
Ophthalmologic Examination Benefit
WHAT IS THE BENEFIT?
In addition to any Optical Benefits, the Fund will reimburse up to $40.00 every 12 months for an eye examination "Refraction only" performed by a Board qualified Ophthalmologist for members and their eligible dependents.
HOW TO OBTAIN THE BENEFIT
Submit a copy of the itemized and dated bill with "Refraction" listed separately, marked paid to the Fund Office for reimbursement. The bill must indicate the name of the patient and the date services were rendered, and the amount of payment by member.
Sunglass Benefit
The sunglass benefit is available to active members only and will be available every 24 months.
If you utilize the participating provider program for Prescription Sunglasses, you will be given the same frame selection as your regular glasses. For sunglasses provided by a non-participating provider, you will be given the current allowance. To check for eligibility and/or to find a network provider please call Davis Vision at 1(888)999-5431 or visit their website at www.davisvision.com. If you choose to obtain the benefit by a non-participating provider you must complete a claim form provided by Davis Vision and mail the claim to the address indicated on the form.
Lasik Surgery for Vision Correction Benefit
This benefit is a reimbursement of $500 per eye. ($1,000 maximum benefit) The benefit is available to the member or spouse or domestic partner and is a once per lifetime benefit.
HOW TO OBTAIN THE BENEFIT
Please submit itemized documentation of procedures to the Fund office. Receipt from the provider must clearly state the services provided, the eye(s) that were treated, the patients name, the date the service(s) were rendered, and the service(s) were paid in full.
Download:
Davisvision Out of Network Form.pdf
DAVIS VISION-APP.png
DavisVision Patient Warranty Info 7-11-18.pdf
OPTICAL ACTIVE MEMBER BENEFIT 11-30-20.pdf
OPTICAL LIMITED PLAN BENEFITS 11-30-20.pdf
OPTICAL RETIREE & COBRA PLAN BENEFITS 11-30-20.pdf
|
