Vision Care Expense Benefit

(For ALL Eligible Participants)

Under the Vision Care Expense Benefit, the Plan pays benefits for the actual cost of your eligible Vision Care Expenses up to the calendar year maximum of $100 per person. (The calendar year maximum does not apply to individuals who are under age 18.)

Covered Vision Care Charges

Covered Vision Care Charges include the following:

1. Complete  vision  examination,  including  dilation  of  pupil  and/or  relaxing  of  focusing muscles by drops when performed by a legally qualified ophthalmologist or optometrist; and

2. New or replacement prescribed lenses, including the fitting of contact lenses, and frames.

For individuals who are under the age of 18, the following limits apply:

a. Exam: Limited to one (1) vision exam per calendar year.

b. Frames:  $50 per prescription (not to exceed one pair of frames per calendar year).

c. Lenses:  $50 per prescription.

d. Contacts (in lieu of frames/lenses):  $100 per prescription.

Exclusions from Vision Care Coverage

No coverage is provided under this Vision Care Expense Benefit for loss or expense caused by, incurred for, or resulting from:

  1. Surgical or medical care for treatment of eye disease and/or injury.
  2. Injury or sickness arising out of or in the course of employment or which is compensable under Workers’ Compensation or Occupational Disease Act or Law.
  3. Declared or undeclared war, or act of war.
  4. Vision care services, screening services or supplies received from a medical department maintained by:
    a. A mutual benefit association
    b. Labor union
    c. Trustee
    d. Employer or
    e. A similar group.
  5. Orthoptics, vision training or aniseikonia.
  6. Expenses incurred for cosmetic or fashion reasons.
  7. Sunglasses, plain or prescription, or safety lenses or goggles.

Filing Vision Claims

Follow these steps to obtain reimbursement:

  1. Have your eyes examined and/or obtain  frames  and/or lenses  from the provider of  your choice.
  2. Pay the bill in full when the services are rendered or the supplies are received.
  3. Obtain a claim form from the Fund Office.
  4. Complete the form and sign in the space provided.
  5. Send  the  completed  form  and  your  paid  receipt  and  mail  to the  Dental/Vision  Claims Administrator as listed in the Contact Information section.

REIMBURSEMENT WILL BE MADE TO YOU BY THE PLAN.

Laborers