Medical Benefits > How Your Prescription Drug Works Under The Plan > Vision Benefits - Pov
Vision Benefits - POV
Establishing
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Vision benefits are part of your medical coverage under the Fund's medical
plans, as shown in the following chart :
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Your vision plan acts as a plan within your medical plan, with its own specific
benefits. Most routine eye care services are covered under the vision plan.
Some services, however, such as treatment for an eye injury or illness, may
be covered under the medical plan's benefits and limitations.
Who's Covered
You and your covered dependents are covered for vision benefits if you're
enrolled in the Regular Plan. Your coverage begins when
you become eligible for medical benefits. Coverage for your dependents begins
after you enroll them in the medical plan and pay the required dependent coverage
premium.
How Your Vision Benefits Work
The plan pays benefits regardless of where you receive vision care services.
Although the vision plan doesn't have a specific network for eye care services,
the Regular Plan's PPO network does include ophthalmologists. (See contact information
in the Summary Of Benefits.)
What You Pay
Regardless of where you go for eye care, you pay the following:
- You must meet either the individual or family deductible before benefits
begin. Your medical calendar-year
deductible applies to both medical and vision care, so you don't have to satisfy
a separate deductible.
- After you satisfy the deductible, you pay the coinsurance, up to a calendar
year maximum benefit.
- If your provider doesn't accept assignment of benefits, you must pay your
provider for vision care expenses up-front, and then submit a claim to the
Fund for reimbursement.
What's Covered
The vision plan includes coverage, up to a calendar-year maximum benefit,
for:
- Frames, prescription lenses and contact lenses; and
- Refractions, tonometry and exams to assess your vision and for prescribing
corrective lenses.
What's Not Covered
The vision plan doesn't cover:
- Non-prescription sunglasses, clip-on sunglasses, or color contact lenses;
- Laser eye surgery;
- Shipping and handling charges; and
- Any cost for services above the calendar-year maximum benefit.
How To File A Claim
For information about filing claims, see "Filing
Claims".
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