Operating Engineers Health & Welfare Fund


Vision Care Plan

 
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Vision Service Plan (VSP)

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Spectera

IMPORTANT: Vision plan coverage will not be available for you or your family members until you select one of these vision plans.  

We encourage you to read the material and select the best plan for your needs.  Vision coverage will be effective on the first day of the month following receipt of your enrollment form.

Vision Service Plan (VSP)
 
If you or your dependent need vision care and have selected Vision Service Plan (VSP), the Fund will provide benefits for:    
Vision Examination: Every 12 months.
Lenses: Every 24 months only if needed.
Frames: Every 24 months only if needed.

You may call VSP at (800-622-7444) for more information, or check the Vision Service Plan website for a directory of participating providers. (Click here for a Vision Enrollment Form).
BENEFITS

The following is a list of benefits available:
 

  1. Vision Examination: A complete analysis of the eyes and related structures to determine the presence of vision problems, or other abnormalities.
     

  2. Lenses: The VSP Panel Doctor will order the proper lenses (only if needed).
     

  3. Frames: The Plan offers a wide selection of frames, however, if you select a frame which costs more than the amount allowed by your Plan (or a large frame that requires oversized lenses) there will be an additional charge.
     

  4. Contact Lenses: Contact lenses are furnished under VSP when the VSP Panel Doctor secures prior approval for the following conditions:

    (a) Following cataract surgery, (b) To correct extreme visual acuity problems that cannot be corrected with spectacle lenses, (c) anisometropia, (d) keratoconus.  When VSP Panel Doctors receive approval for such cases, they are fully covered by VSP.  

    When patients choose contact lenses for other reasons, VSP will make an allowance of $150 toward their cost in lieu of all other benefits for that year.
AMOUNT PAYABLE 

This Plan covers the visual care described herein (examination, professional services, lenses and frames).  There is a $15 deductible for the exam and a $25 deductible for materials (frames and/or lenses) which is your out-of-pocket expense.  Any additional care, service and/or materials not covered by this Plan may be arranged between you and the doctor.
HOW TO USE THE VISION PLAN

  1. You do not need a form to obtain Vision Care Benefits. 

  2. Select the doctor of your choice from the Vision Service Plan list and make an appointment for an examination.  Tell them you are covered by Vision Service Plan and they will determine your eligibility.

  3. When the examination has been completed, the doctor will have you sign your name in the space provided.  Pay only the deductible to the doctor for the services described herein.  VSP will pay the panel doctor directly according to their agreement with the doctor.

  4. Selecting a doctor from the VSP list assures direct payment to the doctor and a guarantee of quality and cost control.  However, if you seek the services of a doctor who is not a VSP Panel Member, you should pay the doctor his full fee.  You will be reimbursed in accordance with the reimbursement schedule below.  There is no assurance that the schedule will be sufficient to pay for the examination or the glasses.  Reimbursement benefits are not assignable.

NOTE:      

When you obtain service from a doctor who is not a VSP Panel Member, and/or obtain glasses from a dispensing optician, be sure to send your itemized statement of charges to VSP.  You will be reimbursed according to the following schedule after satisfaction of the deductibles:
Vision exam $  40.00

Single lenses, up to

 $  40.00
Bifocal lenses, up to $  60.00
Trifocal lenses, up to $  80.00

Lenticular lenses, up to

 $125.00
Frames, up to $  45.00
Contact lenses, necessary $250.00*
Contact lenses, elective $150.00*

*In lieu of all other Plan benefits

Extra Cost

 This plan is designed to cover your visual needs rather than cosmetic materials.  If you select any of the following and your VSP doctor doesn't receive prior authorization, there will be an extra charge: (a) Oversize lenses; (b) coated lenses; (c) contact lenses; (d) blended lenses; (e) multi-focal plastic lenses; or (f) a frame that costs more than the Plan allowance.

Spectera
 
If you or your dependent need vision care and have selection Spectera, the Fund will provide benefits for:    
Vision Examination: Every 12 months.
Lenses: Every 12 months only if needed.
Frames: Every 24 months only if needed.

You may call Spectera at (800-839-3242) for more information, or check the Spectera website for a directory of participating providers. (Click here for a Vision Enrollment Form).
BENEFITS

The following is a list of benefits available:

  1. Vision Examination: A complete analysis of the eyes and related structures to determine the presence of vision problems, or other abnormalities.

  2. Lenses: The Spectera Panel Doctor will order the proper lenses (only if needed).

  3. Frames: The Plan offers a wide selection of frames, however, if you select a frame which costs more than the amount allowed by your Plan (or a large frame that requires oversized lenses) there will be an additional charge.

  4. Contact Lenses: Contact lenses are furnished under Spectera when the Spectera Panel Doctor secures prior approval for the following conditions:

    (a) Following cataract surgery, (b) To correct extreme visual acuity problems that cannot be corrected with spectacle lenses, (c) anisometropia, (d) keratoconus.  When VSP Panel Doctors receive approval for such cases, they are fully covered by Spectera  

    When patients choose contact lenses for other reasons, Spectera will make an allowance of $105 toward their cost in lieu of all other benefits for that year.
AMOUNT PAYABLE 

This Plan covers the visual care described herein (examination, professional services, lenses and frames).  There is a $10 deductible for the exam and a $25 deductible for materials (frames and/or lenses) which is your out-of-pocket expense.  Any additional care, service and/or materials not covered by this Plan may be arranged between you and the doctor.
HOW TO USE THE VISION PLAN

  1. You do not need a form to obtain Vision Care Benefits. 

  2. Select the doctor of your choice from the Spectera Service Plan list and make an appointment for an examination.  Tell them you are covered by Spectera and they will determine your eligibility.

  3. When the examination has been completed, the doctor will have you sign your name in the space provided.  Pay only the deductible to the doctor for the services described herein.  Spectera will pay the panel doctor directly according to their agreement with the doctor.

  4. Selecting a doctor from the Spectera list assures direct payment to the doctor and a guarantee of quality and cost control.  However, if you seek the services of a doctor who is not a Spectera Panel Member, you should pay the doctor his full fee.  You will be reimbursed in accordance with the reimbursement schedule below.  There is no assurance that the schedule will be sufficient to pay for the examination or the glasses.  Reimbursement benefits are not assignable.

NOTE:      

When you obtain service from a doctor who is not a Spectera Panel Member, and/or obtain glasses from a dispensing optician, be sure to send your itemized statement of charges to Spectera.  You will be reimbursed according to the following schedule after satisfaction of the deductibles:
Vision exam $  40.00

Single lenses, up to

 $  40.00
Bifocal lenses, up to $  60.00
Trifocal lenses, up to $  80.00

Lenticular lenses, up to

 $125.00
Frames, up to $  45.00
Contact lenses, necessary $210.00*
Contact lenses, elective $105.00*

*In lieu of all other Plan benefits

Extra Cost

 This plan is designed to cover your visual needs rather than cosmetic materials.  If you select any of the following and your Spectera doctor doesn't receive prior authorization, there will be an extra charge: (a) Oversize lenses; (b) coated lenses; (c) contact lenses; (d) blended lenses; (e) multi-focal plastic lenses; or (f) a frame that costs more than the Plan allowance.