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Health Fund

How Your Vision Benefits Work Under The PPO Plan and Low Option Plan

Outpatient Vision benefits are not available if you enroll in the Low Option Plan.

Your vision plan acts as a plan within your medical plan, with its own specific benefits. Most routine eye care services are covered under the vision plan. Some services, however, such as treatment for an eye injuryBodily harm caused by an accident. The injury must also result, for the purposes of accidental death and dismemberment coverage, directly and independently of all other causes, in a loss covered by the plan. or illnessA sickness or disease that causes loss covered by the plan. Pregnancy is considered a sickness with respect to a covered female participant, the Same-Sex Domestic Partner of a female covered participant and the spouse of a male covered participant only. Pregnancy for dependent children isn't covered, except for complications of pregnancy., may be covered under the medical plan's benefits and limitations.

Who's Covered

You and your covered dependents are covered for vision benefits if you're enrolled in the PPO Plan. Your coverage begins when you become eligible for medical benefits. Coverage for your dependents begins after you enroll them in the medical plan and pay the required dependent coverage premium.

How Your Vision Benefits Work

The plan pays benefits regardless of where you receive vision care services. Although the vision plan doesn't have a specific network for eye care services, the Medical Plan's PPOAn acronym for Preferred Provider Organization. network does include ophthalmologists. (See contact information in the Summary Of Benefits.)

What You Pay

Regardless of where you go for eye care, the following applies:

What's Covered

The vision plan includes coverage, up to a calendar-year maximum benefit, for:

  • Frames, prescription lenses and contact lenses; and
  • Refractions, tonometry and exams to assess your vision and for prescribing corrective lenses.
What's Not Covered

The vision plan does not cover:

  • Non-prescription sunglasses, clip-on sunglasses, or color contact lenses;
  • Laser eye surgery;
  • Shipping and handling charges; and
  • Any cost for services above the calendar-year maximum benefit.
How To File A Claim

For information about filing claims, see "Filing Claims", page 49.

* Dependents under the age of 18 years old are not subject to the $200 calendar-year maximum benefit for vision benefits that are determined to be essential health benefits.