Vision Care charges for one pair of glasses (lenses and frames) or one purchase of contact lenses, when prescribed by a legally qualified Ophthalmologist or Optometrist, up to the maximum shown in the “SUMMARY OF BENEFITS”. Members choosing to purchase disposable contact lenses should note that only one claim is allowed in any 24 month period, and therefore should consider buying in quantity.  No amount is payable for replacement of lost or stolen glasses, broken glasses, duplicate glasses, safety or sunglasses, anti-reflective coatings, or for tints other than No. 1 or No. 2.

The Vision Care maximum specified in the “SUMMARY OF BENEFITS” includes one eye examination for claimants between the ages of 19 and 64, in any period of 24 consecutive months.

How to File a Vision Care Claim

A properly completed Vision Care claim form is required for each insured family Member.   Paid receipt of purchase must be attached.
Each Vision Care claim must show the:

1. patient's full name
2. charge for lenses
3. charge for frames
4. charge for miscellaneous items

Proof of Loss

Written proof stating the occurrence, character and extent of loss must be submitted for each benefit to the administrator within 12 months after the date of the loss, but not more than 3 months after the date coverage terminates, for Extended Health Care Benefits.