Using the Vision Care Plan Vision Care Exclusions           Home

UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS                                   HEALTH and WELFARE FUND

 

Vision Care Plan

To qualify for vision care benefits, you must use a Group Vision Associates (GVA) participating provider. Under the Plan, you and your eligible dependents may have a complete eye examination once every 12 months at no cost to you. The cost of new lenses is covered once every 24 months. Single-vision lenses and standard bifocals, including round, flat-top and executive, are provided by the Plan at no cost. You may order plastic or glass lenses. However, if you need other types of lenses or if you want any extras, such as tinted lenses, scratch coatings, etc., you may have to pay the difference between those items and the cost of the regular lenses, plus a small service charge. You are also covered for up to $25 toward the wholesale cost of one pair of new frames every 24 months. If you break your lenses or if your vision changes, you can have the lenses replaced after 12 months. If your frames break, you can also have them replaced after 12 months (up to the $25 Plan maximum). If you wear contact lenses, the Plan pays a $75 allowance once every 12 months from the date of your last covered service toward the total amount of the examination, fitting, and the lenses. No other vision care benefits are payable in addition to the contact lens allowance. Using the Vision Care Plan To use the Plan, you must first contact the Fund office for a list of participating GVA providers and a claim form. Select a doctor from the list and make an appointment. Please check with the doctor of your choice when making your appointment to make certain he or she is still participating. Bring the claim form with you and sign it after your doctor completes his or her services. Claim forms must be filed by the GVA participating provider within 30 days from the date of the examination. If you or your dependents are covered for vision benefits under any other plan, please refer to the section titled “Coordination of Benefits” to see how to submit your claims. Vision Care Exclusions Some vision care expenses are not covered. These include, but are not limited to:   Special procedures, such asorthoptics, aniseikonic lenses, etc.   Contact lenses and related services, other than the $75 allowance once every 12 months.   Medical or surgical treatment of the eyes.   Vision care or materials provided by federal, state or local government.   Services or materials covered under Workers’ Compensation.   Sunglasses (plain or prescription).   Services performed by a provider who does not participate with GVA.   Replacement of lost or stolen glasses. If you are not certain whether a service is covered under the Vision Care Plan, contact the Fund office before you seek routine vision care.