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Reimbursement schedule

  1. The provider (or in the case of direct reimbursement, the member) shall receive payment of the usual and customary charge or up to $125.00, whichever is less, from the Fund for a complete service which includes single vision, bifocal or trifocal lenses, a basic frame and eye exam.
  2. The provider (or in the case of direct reimbursement, the member) shall receive payment from the Fund of the usual and customary charge or up to $125.00, whichever is less, for any partial service rendered. A partial service includes only a frame or lenses.
  3. The provider (or in the case of direct reimbursement, the member) shall receive payment from the Fund of $20.00 for an eye exam only.
    Note: If mandated by state law, panelists outside of New York State are allowed to charge the member the difference between the mandated price and our fee schedule.
  4. The provider (or in the case of direct reimbursement, the member) shall receive payment of $125.00 from the Fund towards the purchase of contact lenses. The member/patient is responsible for the balance.
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