SCHEDULE OF BENEFITS - OPTICAL
| BENEFIT DESCRIPTION |
DEDUCTIBLES/CO-PAYMENTS/CO-INSURANCE |
LIMITATIONS |
PRE-CERT REQD? |
| Optical Benefit |
No Deductible;
No Co-payment; |
$180 per person per calendar year;
Maximum accumulation of $360 every 2 calendar years; |
No |
| Optical Benefit - Lasik Vision Correction Benefit |
No Deductible;
No Co-payment; |
$600 per person per lifetime |
No |
Optical benefits are payable for any combination of any treatment of services relating to Lasik Vision Correction.
Pensioner Optical Benefits are those in effect on your Pension Effective Date.
Exclusions and Limitations:
- Benefit limited to refractions, prescription eyeglasses, prescription safety lenses, prescription contact lenses, prescription sunglasses, and refractive surgery.
- Any unused optical benefit may be carried over from one calendar year to the next, but in no event shall a benefit accumulate for more than two calendar years.