Vision, Prescription & Dental Coverage
Retiree Benefits Overview
Comprehensive coverage options for PFT retirees including vision care, prescription medications, and dental services.
Overview
- •Administered by: National Vision Administrators (N.V.A.)
- •Available to: PFT Retirees
- •Benefit Periods: There are no limitations
- •Cost: $12.00 yearly premium - Retiree pays entire reduced cost
Purpose
To provide thorough vision analysis (including Tonometry test), lenses manufactured to exacting standards and a wide selection of quality frames at a controlled cost
Basic Charges
If you elect to use one of the participating optometrists, ophthalmologists, or opticians, there is a basic charge for:
| Service | Cost |
|---|---|
| Examination | Retail less $10.00 |
| Retinal Screening | $39.00 |
| Regular Lenses (2) | Up to $35.00 |
| Bifocal (2) | Up to $55.00 |
| Trifocal (2) | Up to $70.00 |
| Frames | Retail Less 35% |
| Contacts* Evaluation/Fitting | Retail Less 10% |
| Conventional Contacts | Retail Less 15% |
| Disposable Contacts | Retail Less 10% |
| *Medically Necessary contact lenses are not covered under the plan. | |
Lenses & Services
ALL CHARGES ARE MONITORED BY N.V.A. - INCLUDING EXTRAS
Lens options purchased from a participating NVA provider will be provided to the member at the amounts listed in the fixed option pricing list below. NVA members will only pay the fixed maximum amount or the provider's wholesale cost, whichever is less.
| Option | Price |
|---|---|
| Polarized | $75 |
| Blue Light Blocker (Standard) | $45 |
| Ultraviolet Coating | $12 |
| Polycarbonate (Single Vision) | $35 |
| Polycarbonate (Multi-Focal) | $35 |
| Scratch-Resistant Coating (Standard) | $15 |
| Transitions Single Vision (Standard) | $65 |
| Transitions Multi-Focal (Standard) | $70 |
| Solid Tint/Gradient | $12 |
| Progressive Lenses Standard** | 50$ |
| **Fixed pricing not available on certain brands | |
Important Notes
- •Options not listed will be priced by NVA providers at their reasonable and customary retail price less 20%
- •In certain states, members may be required to pay the full retail amount and not the negotiated discount amount at certain participating providers
- •Some optometrists affiliated with Optical Retail locations (i.e., Visionworks, etc.) are independent providers and may not participate in the NVA program
- •Participating providers are not contractually obligated to offer sale prices in addition to outlined coverage
- •Regardless of medical or optical necessity, vision benefits are not available more frequently than specified in your policy
How Does an Eligible Person Use the PFT Retirees N.V.A. Vision Program?
- 1.View our list of eligible vision providers
- 2.Make an appointment and notify the NVA participating provider that your coverage is administered by NVA and sponsored by The Philadelphia Federation of Teachers
- 3.The provider will inform you of your eligibility prior to rendering any services
RETIREE Rx – Under Age 65
Plan: Capital Rx
Enrollment Deadline
| Type | Co-Pay |
|---|---|
| Brand Name | $40.00 |
| Generic | $11.25 |
Retail or Mail Order provides up to a 60-day supply for one co-pay
RETIREE Rx – Over Age 65 or Enrolled in Medicare
Plan: Independence Blue Cross Select Option (PDP) Plan
Enrollment Deadline
| Supply | Brand Co-Pay | Generic Co-Pay |
|---|---|---|
| 90-day supply | $60.00 | $15.00 |
| 30-day supply | $40.00 | $10.00 |
Mail order and Retail provide 90-day supply
Eligibility
You are eligible if you meet one of the following criteria:
- •Retired under a State Early Retirement Plan (30 years of service or more) – no age requirement
- •Retired from a PFT bargaining unit and are at least 65 years of age
- •Approved PSERS Disability Retirement and/or the Health and Welfare Fund's Long Term Disability benefit
- •Retired from a PFT bargaining unit and are at least age 55 with a combination of age and years of service that equal 65 or more
Costs & Billing
$840 Billed twice yearly:
- •Payment is due on January 2nd For the 6-month period starting March 1st
- •Payment is due on July 2nd For the 6-month period starting September 1st
No Re-enrollment
Payment Options
Retired members who have enrolled in the PFT Health & Welfare Retiree Prescription Plan may make their payments online through our member dashboard.
How to Enroll in Retiree Rx Benefits
Retiree Enrollment Packet
Under 65 Retiree Enrollment Packet
This packet includes several files to help you enroll in the PFT Health & Welfare Funds Programs. Please upload the completed forms to our secure upload portal or UCCI per the instructions on the letter.
- Retiree Letter - Under 65
- PFTHW Retiree Benefit Application (Writable)
- Retirement Prescription Application (Writable)
- NVA Vision Benefit Summary
- United Concordia Enrollment/Change Form
PDF • 1.39 MB
Over 65 Retiree Enrollment Packet
This packet includes several files to help you enroll in the PFT Health & Welfare Funds Programs. Please upload the completed forms to our secure upload portal or UCCI per the instructions on the letter.
- Retiree Letter - Over 65
- PFTHW Retiree Benefit Application (Writable)
- Retirement Prescription Application (Writable)
- United Concordia Enrollment/Change Form
- NVA Vision Benefit Summary
PDF • 1.39 MB
IBX PDP Application
Medicare Prescription Drug Plan Employer Group Enrollment and Change Form
PDF • 172 KB
- Upload the completed packet with the following documents at our secure document upload page
- •Page one (1) of your PSERS estimate
- •A copy of your current medical card
Turning 65?
Retirees on the Capital Rx Plan who are turning age 65 will be automatically enrolled in the Independence Blue Cross Select Option (PDP) Plan.
Opt-Out Option
Medicare IRMAA (Income-Related Monthly Adjustment Amount)
Be advised that depending on your annual income, Medicare may charge you an income-related monthly adjustment amount (IRMAA).
The sliding scale charge is a set of statutory percentage-based tables to adjust Medicare Part B and prescription drug coverage Medicare Part D premiums. The higher the beneficiary's range of modified adjusted gross income (MAGI), the higher the IRMAA will be.
Learn More About IRMAADental Coverage — United Concordia Retiree Plan
Comprehensive dental care for retirees and dependents
Eligibility & Rates
Retirees and eligible dependents may enroll.
Rates (Billed Quarterly by United Concordia)
| Coverage | Monthly | Quarterly |
|---|---|---|
| Individual | $34.48 | $103.44 |
| Two People | $62.81 | $188.43 |
| Family | $81.59 | $244.77 |
Benefit Comparison: Retiree vs. Active Member
| Benefit Category | Retiree Plan | Active Member Plan |
|---|---|---|
| Routine Examinations | 80% - once every 6 months | 100% of total allowable fee |
| Oral Prophylaxis (Teeth Cleaning) | 80% - once every 6 months | 100% of total allowable fee |
| Fluoride Application | 80% - once every 6 months | 100% of total allowable fee |
| Pit & Fissure Sealants | Not Covered | 100% - once every 36 months (unless special need shown) |
| Bitewing X-ray | 80% - once every 6 months | 100% of total allowable fee |
| Root Canal Treatment (under local anesthesia) | 50% | 100% of total allowable fee |
| Apicoectomy (Root surgery) | 50% | 50% of total allowable fee |
| Restorative Services | 50% | 100% |
| Single Unconnected Inlays, Onlays & Crowns | 50% | 80% |
| Removal of Impacted Teeth (under local anesthesia) | 50% | 80% |
| Most Other Oral Surgery (under local anesthesia) | 50% | 80% |
| Periodontics - Non-Surgical (under local anesthesia) | 50% | 50% |
| Periodontics - Surgical (under local anesthesia) | 50% | 50% |
| Fixed Bridgework (including abutment inlays, onlays, crowns & pontics) | 50% | 50% |
| Fixed Bridge Replacement | 50% - if at least 5 years since initial installation | 60% without limitation, as required |
| Repairs to Fixed Bridges | 50% - 100% | 50% |
| Full or Partial Dentures | 50% | 50% |
| Denture Replacement | 50% - if at least 5 years since initial installation | 50% - only 5 years since insertion and only if unserviceable |
| Repairs to Removable Prosthetics | 50% - 100% | 60% - 100% |
| Orthodontic Services | Not Covered | 50% with $1,200 lifetime maximum |
| Deductibles | No Deductible | No Deductible |
| Maximum Benefits | $1,500 per person per year | No annual cap |
| Out-of-Area Emergency Services | Covered as specified above | Covered as specified above |
Key Differences
Finding a Dental Provider
United Concordia has a network of participating dental providers. Find a dentist near you who accepts your retiree dental coverage.
View Dental ProvidersImportant Notes
Critical reminders for maintaining your benefits
Payment Deadlines
Provider Verification
Coverage Variations
Questions or Concerns?
Our member services team is here to help with eligibility, benefits, claims, and everything in between. Reach out — we'll point you to the right person.