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Basic Program
Conditions
Alternative
N.V.A. Vision Program
Vision Care Programs
- You may choose either the Basic Program or the Alternate N.V.A. Vision Plan
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BASIC PROGRAM
Basic Program
Reimbursement—You are reimbursed after payment
- Examinations--Once every calendar year--up to $25.00 an examination
- Lenses--Once every two calendar years unless a change is required in the calendar year as a result of the above examination
- regular lenses (two)...Up to $24.00
- bifocal lenses (two)...Up to $38.00
- trifocal (two)...Up to $56.00
- lenticular (two)...Up to $64.00
- Frames--Once every two calendar years unless a change is required in the next calendar year as a result of the above lens change...Up to $24.00
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How does an eligible person obtain Basic Vision Benefits?
- Obtain a form from your Building Representative.
- Choose a legally qualified ophthalmologist, optometrist or optician.
- Complete your portion of the form--have the ophthalmologist, optometrist or optician complete the appropriate portions of the form.
- Send completed form to the PFT Health and Welfare Office.
- You will be reimbursed directly.
- If you are not eligible, you will not receive any reimbursement. Back
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CONDITIONS
Who is Eligible?
- Member of a PFT bargaining unit that is eligible for Vision Benefits and who has completed ten pay periods or five months, whichever is shorter
- The spouse
- Dependent children up to attainment of age 19
- Dependent children up to attainment of age 25 (if the child was eligible
for coverage as a dependent prior to age 19), living at home, enrolled in a post-high school educational program
- Incapacitated dependent children, 19 years or over Back
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Benefit Periods
- Examination--Every calendar year
- Lenses and frames once every two calendar years unless a lens change (.5 diopters) is required
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Contact Lenses
- Contact lenses--Only if medically required as verified by the PFT Health and Welfare Doctor--up to $80.00 a lens (contact Health & Welfare Office)
- Contact lenses that are not medically required will receive an allowance of $73.00 (including the examination)
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Exclusions and Limitations
- Expenses for which benefits are payable under any Workers' Compensation Law
- Special procedures such as surgical or medical treatment of the eyes, orthoptics, and visual training
- Replacement of lost, stolen or broken lenses and/or frames (until allotted waiting period stated above has been completed)
- Services or supplies not listed in the Benefits listed above
- Expenses for services or supplies for which no payment is required of the member
- Expenses for service and supplies unless they are prescribed by a legally qualified ophthalmologist, physician, optometrist, or optician
- In the event a member, spouse or an eligible dependent is entitled to receive payment from any other source, then in such event the liability of this Fund is limited solely and completely to the payment of the excess, if any, of the amount otherwise payable by this Fund. (Submit to other Program first--then send copy of their form showing payment with the PFT Vision Care form.)
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ALTERNATIVE
N.V.A. VISION PROGRAM
Purpose
- To provide thorough vision analysis (including Tonometry test), lenses manufactured to exacting standards and a wide selection of quality frames with
NO OUTLAY OF MONEY by the member!
- To control the cost of more expensive frames and cosmetic items such as tints and photograys so that the member may save money. The savings could be as much as 50% of the retail cost.
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If You Elect to Use One of the Participating Optometrists or Ophthalmologists
--there is No Out-Of-Pocket Payment For:
- examination
- fitting fee
- any frames whose wholesale cost is $24.00 or less
- regular size lenses (single or multifocal) Back
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Frames
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Your $24.00 allowance is applied to the wholesale cost of the frames. These typically sell at retail prices that range from $48.00 to $72.00. Currently, your basic plan pays you an allowance after you've paid the retail price.
- If you pick more expensive frames you pay the difference between the $24.00 and the actual wholesale cost plus 20% of this difference.
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ALL CHARGES ARE MONITORED BY N.V.A.
Using an Unlisted Doctor
-
You may use an unlisted Doctor (use basic form) and use a listed provider (special form). However, check your list of providers carefully in order to see which ones will fit and make glasses without an examination.
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Extras
- You pay wholesale cost. N.V.A. monitors charges. Back
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Payments
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Your basics, as listed above, are covered by the fund. You pay the Optometrist or Ophthalmologist for the extras.
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How does an eligible person obtain the N.V.A. Vision Form?
- Obtain a Request for an N.V.A. Plan Form from your Building Representative.
- Mail the Request in to the PFT Health and Welfare Office.
- You will receive, in the mail, an N.V.A. Form with the name of the requested eligible person, and a list of eligible providers. The form will also have an expiration date on it.
- Choose a listed provider. Make an appointment for a date prior to the expiration date on the form. The expiration date is valid as long as the person listed is eligible.
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