Retiree Health & Welfare
Health & Welfare Plan
Vision Benefits
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The Fund contracts with Vision Service Plan (VSP) to offer vision benefits to all Participants and their Eligible Dependents, except for those enrolled in the COBRA Core Plan, Plan M, and Medicare Retirees in a Medicare Advantage Plan.
How To Use The Benefit
- Locate a VSP doctor by calling (800) 877-7195 to request a list of participating doctors or by visiting the VSP website at www.vsp.com.
- Call the doctor of your choice and make an appointment. Identify yourself as a VSP member through Operating Engineers Health and Welfare Fund.
- At your appointment, pay only the deductible for the covered services. VSP will pay the doctor directly for the balance of the charges.
Benefits Through VSP
| Service | Deductible or Co-Pay | Limitations |
|---|---|---|
| Eye Examination | $15 deductible | Once every 12 months |
| Contact Lens Examination | Not to exceed $60 | Once every 12 months |
| Lenses and Frames | $25 deductible | Once every 24 months |
| Second Pair of Lenses and Frames | $65 co-pay | Once every 24 months for Employee only |
Vision exams include a complete analysis of the eyes and related structures to determine the presence of vision problems or other abnormalities.
Lenses will be ordered by the VSP doctor only if needed.
Extra Costs
The Plan is designed to cover your visual needs rather than cosmetic materials. If you select any of the following and your VSP doctor does not receive prior authorization, there will be an extra charge: oversize lenses, coated lenses, contact lenses, blended lenses, multi-focal plastic lenses, or a frame that is more than the Plan allowance. There is a 20% discount on the overage amount.
Contact lenses are covered when the VSP doctor secures prior approval for the conditions listed below:
- Following cataract surgery
- To correct extreme visual acuity problems that cannot be corrected with spectacle lenses
- Anisometropia
- Keratoconus
If the VSP doctor receives approval, the lenses are fully covered by VSP.
Using a doctor from the VSP list assures direct payment to the doctor and a guarantee of quality. If you use a non-VSP doctor, you must pay the doctor the full fee, obtain an itemized bill from your doctor and submit the bill to VSP, along with a VSP benefit form (available from VSP). You will be reimbursed by VSP in accordance with the reimbursement schedule below after satisfaction of the deductibles. There is no guarantee that the schedule will be sufficient to cover the cost of the services and supplies provided.
| Service or Supply | Amount Payable |
|---|---|
| Vision Exam | $40 |
| Single Lenses | Up to $40 |
| Bifocal Lenses | Up to $60 |
| Trifocal Lenses | Up to $80 |
| Lenticular Lenses | Up to $125 |
| Frames | Up to $45 |
| Contact Lenses (necessary) | $250 in lieu of other Plan benefits |
| Contact Lenses (elective) | $150 in lieu of other Plan benefits |
Eye Surgeries
Cataract Surgery
In addition to the normal surgical benefits, you may also be eligible for eye glasses at the time of surgery through VSP.
Laser Eye Surgery
The Plan will provide benefits for laser eye surgery only if the surgery on either eye or both eyes is medically necessary to correct severe progressive myopia involving refractive errors of negative 5 or greater. This benefit is subject to a lifetime maximum of $3,500.
Covered laser surgeries include:
- Laser-assisted in situ keratomileusis (LASIK)
- Laser epithelial keratomileusis (LASEK)
- Photoreactive keratectomy (PRK)
Note: VSP offers discounts on laser eye surgeries that may not otherwise qualify for coverage. Contact VSP for details.
Revised 09/2023