There are two ways to obtain vision coverage under the Plan:
• visit a VSP vision care professional
• select another provider not affiliated with VSP
When you receive services from a VSP provider, vision surveys, frames, necessary lenses, contact lenses, and safety glasses are covered at 100% of the allowance once per every two calendar years, unless your prescription changes and meets certain specified criteria.
Claims must be submitted within six months of the date of service.
Note: This benefit provided for Standard Plan (full) coverage only; no provision for “H” Plan (limited) coverage.
Regular eye care is an important part of your overall health. That’s why the Fund has contracted with Vision Service Plan (VSP) to provide vision care services at no cost or at discounted rates. This arrangement represents a considerable savings to you when compared with the cost of such services outside the panel of providers. You are still eligible to receive vision care benefits if you do not go to a VSP Panel provider for services; however, your out-of-pocket expenses may be higher.
What You Need To Do
To find a participating provider near you, visit the VSP website (www.vsp.com) or contact VSP at 1-800-877-7195. When you call to make your appointment, identify yourself as a member of the EWTF. If you use a non-VSP provider, you or the eye doctor should submit a detailed bill itemizing charges directly to VSP at the following address:
Attn: Out-of-Network Provider Claims
Vision Service Plan
PO Box 997100
Sacramento, CA 95899-7100
When you use a VSP provider, you may have a vision exam and, if indicated, a complete vision analysis, once per every two calendar years, at no cost to you. In addition, if lenses for eyeglasses are prescribed, the Plan pays 100% of the allowance once per every two calendar years.
New frames (chosen from a designated selection of styles) are paid in full up to the amount of the $150 allowance every two calendar years. If you select contact lenses, the Plan pays $100 toward their cost once per every two calendar years.
If your prescription changes before you are eligible for new frames, lenses or contacts and the following criteria are met, your lenses and frames or contacts will be replaced every one calendar year instead of every two calendar years:
- A new prescription differs from the original by at least .50 diopter sphere or cylinder;
- An axis change of 15 degrees or more; or
- .5 prism diopter change in at least one eye.
Benefits paid to non-VSP providers are limited to the allowances payable to VSP providers.
These benefits may not cover 100% of the charge. If your vision care provider charges more than the VSP allowance, you are responsible for the charges that exceed the allowance amount. You must mail your claim to VSP within six (6) months of the date you receive vision services. Claims received after this period will not be honored.
Safety glasses are available to actively working eligible Members once each calendar year. Lenses are covered in full. Safety frames are covered up to $65 plus 20% of any out-of-pocket costs.
Computer glasses are available to actively working eligible Members. If computer glasses are prescribed, the Plan pays 100% of the allowance once every two (2) calendar years. New frames shall be paid in full up to the amount of the $90 allowance every two calendar years.
What’s Not Covered
This benefit does not cover expenses in connection with the following treatments or supplies:
- Non-prescription glasses;
- Photosensitive, plastic, cosmetic tinted (other than pink 1 or 2) or oversized lenses, although you have the option of paying the difference in cost between these lenses and the cost of clear, standard size lenses;
- Replacement or repair of lost or broken lenses or frames;
- Orthoptics, vision training, or vision aids for aniseikonia;
- Medical or surgical treatments, as these are provided for under other provisions of the Plan such as post-cataract lenses or implants;
- Eye surgery for conditions which routinely can be corrected through corrective lenses (e.g. laser correction surgery); and
- Any eye examinations or the fitting of glasses except as provided above.