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 also available by calling the Fund’s hotline at 212-539-0539.
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.
- A complete pair of eyeglasses includes:
- A pair of single vision, bifocal or trifocal lenses, and
- A basic frame.
- A basic frame is defined as any frame with a minimum retail value of one hundred ($100.00) dollars.
- 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.
- Prescription sunglasses are a covered benefit.
- 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.
What is not covered under the Optical Program?
The Optical Plan does not cover non-prescription sunglasses even if recommended by a physician for therapeutic reasons.
Note: The following will not be honored for reimbursement:
- Expired certificates beyond the eligibility period as stated on the certificate.
- Non-original certificates. All valid certificates must be original.
- Certificates used by another person in the members' family. The certificate is only valid for the person whose name appears on the certificate as the patient.