- PARTICIPATING OPTICAL CENTERS
Members can use the service once every two (2) years by bringing a validated certificate to any of the participating optical centers. The service, if used at a participating optical center, includes a DISCOUNTED benefit, described in this chapter. - DIRECT REIMBURSEMENT PROGRAM
For those members who wish to use their optical service at any non participating optical provider, they may submit their validated certificate along with original receipts for reimbursement.
Important Information
FOR VALIDATED FORMS CALL THE FORMS HOTLINE:
212-539-0539
Who is covered?
All eligible members and dependents, as defined in the General Information section, are covered for optical benefits.
What is the benefit?
The optical benefit consists of one (1) “optical service” every two (2) years (counted from the date of your last optical service) obtained through a network of participating panelists or direct reimbursement. The listing of participating panelists is available by calling the Fund’s hotline at 212-539-0539 or online at www.uftwf.org.
An optical service consists of a complete pair of single vision, bifocal or trifocal eyeglasses, or the replacement of a frame, or lens, and at the same time, if necessary, an eye exam*. The optical service cannot be split between two (2) visits or two (2) panelists.
1. A complete pair of eyeglasses includes:
a. A pair of single vision, bifocal or trifocal lenses,
AND
b. A basic frame.
2. A basic frame is defined as any frame with a minimum retail value of one hundred ($100.00) dollars.
3. A basic eye exam, as performed by an optometrist, will encompass a refraction which includes a retinoscopy, a tonometry (glaucoma test), and a physical health evaluation and history. If the patient and optometrist agree that dilation is required, the optometrist is allowed to charge the member an additional $30.00.
4. Prescription sunglasses are a covered benefit.
5. You may elect to purchase contact lenses and receive a credit as per the fee schedule.
*Laws in certain states such as New Jersey, Connecticut and Florida prohibit examinations at certain optical centers or mandate a specific charge for certain specified services. Members are advised to check with centers outside New York State to determine if the eye examination is provided by that center without additional cost. In any event, the Welfare Fund will not reimburse any co-payments for exams.
How are benefits obtained?
1. You must obtain an Optical Benefit Certificate by requesting it from the Fund Office or by calling the Forms Hotline at 212-539-0539. This request must indicate whom the service(s) are for, so that the Fund may verify eligibility prior to issuing the certificate(s).
2. You may obtain the service(s) from a participating panelist, or a non-participating provider whereby you must submit for direct reimbursement.
3. Certificates will not be honored for payment if the patient information is altered in any way.
Please Note: Certificates are not transferable. Photocopied certificates will not be accepted. Certificates cannot be faxed.
How do I use the Participating Panelist Program?
1. Present the validated certificate to any of the Participating Optical Panelists designated on the current list of Welfare Fund Optical Centers. Validated certificates must be presented to the Panelist before the expiration date. If the certificate has not been used within the period, a replacement may be obtained.
2. Panelists are not required to accept a validated certificate after an order is placed.
3. Upon completion of the service at the Participating Optical Panelist, make sure to sign and date Part 6 of the certificate before leaving the store. Payment will be made directly to the Participating Optical Panelist.