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Direct Reimbursement Program

What is the Direct Reimbursement Program?

Under direct reimbursement, which can only be used if you utilize a non-participating provider, you are required to pay for the full cost of the service at the optician and submit to the Fund for payment. Reimbursement is made in accordance with the fee schedule or the actual charge, whichever is less.

How do I get reimbursed?

  1. Attach an original, paid, itemized receipt and a copy of the prescription to the validated certificate. Altered or photocopied receipts will not be accepted. Sign and date Part 6 and mail it to the Welfare Fund office for reimbursement.
  2. Reimbursement for covered services is made in accordance with the fee schedule in effect at that time, not to exceed the actual charges.
  3. Claims must be submitted for payment no later than ninety (90) days from the date of service.

What is not covered under the Direct Reimbursement Program?

  1. Services rendered at participating optical panelists.
  2. Assignment of payment to a provider.