OPTICAL
Who is Eligible:
· Full time employees and eligible dependents.
· Retirees and eligible dependents.
Benefit Defined:
· Reimbursement Allowance - The Fund will reimburse up to $75 in any calendar year for each eligible participant for optical services obtained from any licensed optometrist, ophthalmologist or optician. In the event a participant eligible in the preceding calendar year did not use any portion of his/her optical benefit that participant shall be entitled to a benefit reimbursement up to $150.
· Participating Providers - While in no way endorsing the use of Participating Providers participants may choose from a list of participating providers who have agreed to provide specific benefits within the reimbursement allowances set forth above. A list of providers can be obtained from the Fund office.
Coordination of Benefits: This benefit must be coordinated with any other plan under which a similar benefit is provided so that the total benefits available will not exceed 100% of the actual charges paid.
Filing Requirements:
· Participating providers – benefits assigned.
· Direct Reimbursement - Claims must be submitted with 12 months of the date of service. Limitations: A person may not have coverage as both an Insured Person and as a covered dependent. Only one eligible spouse may cover the eligible children as eligible dependents.
Optical Form