Faculty & Staff

Vision Benefits

Vision benefits are separate from and in addition to the Medical Benefits of this Plan.

Vision Covered Expenses

Subject to the limits in the Summary of Benefits, the Plan pays the Maximum Allowable Charge for vision care services, as follows:

Vision Examinations

Subject to the limits in the Summary of Benefits. The Plan pays 80% of Usual and Customary charges for one examination per Covered Person in any Calendar Year (January 1 through December 31).

Frames, Lenses, and Contact Lenses

Subject to the limits in the Summary of Benefits. The Plan pays for frames, lenses, and contact lenses, including safety goggles and sunglasses to a Calendar Year (January 1 through December 31) maximum per Covered Person of $125.00.

Vision Exclusions and Limitations

The following Exclusions and limitations are in addition to those set forth in the sections entitled “General Limitations and Exclusions,” and “Summary of Benefits”:

Consultations

Consultations.

Enrolled in a Training Program

Services performed by a Physician or other Provider enrolled in an education or training program when such services are related to the education or training program, except as specifically provided herein.

Eye Refractions

Eye refractions, eyeglasses, contact lenses, or the vision examination for prescribing or fitting eyeglasses or contact lenses (except for aphakic patients, and soft lenses or sclera shells intended for use in the treatment of Disease or Injury).

Glaucoma

Treatment of glaucoma, cataract surgery and one set of lenses (contacts or frame-type).

Greater Coverage

Any charges that are covered under a medical or health plan that reimburses a greater
amount than this Plan.

Non Prescription Lenses

Charges for lenses ordered without a prescription or lenses that do not require a prescription.

Orthoptics

Charges for orthoptics (eye muscle exercises).

Radial Keratotomy

Radial keratotomy or other plastic surgeries on the cornea in lieu of eyeglasses.

Vision Training

Charges for vision training or subnormal vision aids.