PFT Vision Care Programs

Benefit Periods

  • Examination – Every calendar year
  • Lenses and frames once every two calendar years unless a lens change of .5 diopters is required
  • Contacts Lenses and Contact Lens Fitting – Every calendar year

Exclusions & Limitations

  • Expenses for which benefits are payable under any Workers’ Compensation Law
  • Special procedures such as surgical or medical treatment of the eyes, orthoptics, and visual training
  • Replacement of lost, stolen or broken lenses and/or frames (until allotted waiting period stated above has been completed)
  • Services or supplies not listed in the Benefits listed above
  • Expenses for services and supplies for which no payment is required of the member
  • Expenses for services and supplies unless they are prescribed by a legally qualified ophthalmologist, physician, optometrist, or optician
  • In the event a member, spouse or an eligible dependent is entitled to receive payment from any other source, then in such event the liability of this Fund is limited solely and completely to the payment of the excess, if any, of the amount otherwise payable by this Fund. (Submit to other Program first – then send copy of their form showing payment with the PFT Vision Care form.)

 

 

Basic Program

Basic Program Reimbursement

– You are reimbursed after payment

  • Examination – Every calendar year – up to $25.00 an examination
  • Lenses – Once every two calendar years unless a change is required in the calendar year as a result of the above examination.
    • regular lenses (two)……Up to $24.00
    • bifocal lenses (two)……Up to $38.00
    • trifocal lenses (two)……Up to $56.00
  • Frames – Once every two calendar years unless a change is required in the next calendar year as a result of the above lens change…Up to $24.00
  • Contact Lenses – only if medically required as verified by a PFT Health and Welfare Fund Doctor – up to $80.00 a lens
  • Contact lenses that are not medically required will receive an allowance of $100.00

How does an eligible person obtain Basic Vision Benefits?

  • Obtain a form here. You can also have one mailed to you by calling 215-561-2722.
  • Choose a legally qualified ophthalmologist, optometrist or optician.
  • Complete your portion of the form – have the ophthalmologist, optometrist or optician complete the appropriate portions of the form.
  • Send completed form to the PFT Health and Welfare Office by regular mail or email the form to document@pfthw.org.
  • You will be reimbursed directly.
  • If you are not eligible, you will not receive any reimbursement.

Note: Basic Vision Program may be coordinated with the Davis Vision from your Keystone Medical Plan. Please contact the PFT Health and Welfare Fund, if you have any questions or concerns at 215-561-2722.

N.V.A. Vision Program

Purpose

  • To provide thorough vision analysis (including Tonometry test), lenses, and a selection of frames with no outlay of money by the member, depending on the type of lenses and frames you chose.
  • To control the cost of more expensive frames and cosmetic items such as tints and photograys so that the member may save money. The savings could be as much as 50% of the retail cost, again, depending on the choices you make.

If you elect to use one of the participating
optometrist or ophthalmologists there is no out-of pocket
payment for:

  • Examination
  • Fitting fee for frames
  • Fitting fee for contacts
  • Any frames whose wholesale cost is $24.00 or less
  • Regular size lenses (single or multifocal)

Frames

Your $24.00 allowance is applied to the wholesale cost of the frames. These typically sell at retail prices that range from $48.00 to $72.00.

  • If you pick more expensive frames, you pay the difference between the $24.00 and the actual wholesale cost, plus 20% of this difference.
  • ALL CHARGES ARE MONITORED BY N.V.A.

Contacts

  • Contact Lenses – only if medically required as verified by a PFT Health and Welfare Fund Doctor – up to $80.00 a lens
  • Contact lenses that are not medically required will receive an allowance of $100.00.

Using an Unlisted Doctor

You may use an unlisted Doctor (use basic form) and use a listed provider. However, check your list of providers carefully in order to see which ones will fit and make glasses without an examination.

Extras

You pay wholesale cost. N.V.A. monitors charges.

Lens options purchased from a participating NVA provider will be provided to the member at the amounts listed in the fixed option pricing list below:

 

  • $75 Polarized
  • $40 Blue Light Blocker (Standard)
  • $60 Blue Light Blocker (Premium)
  • $150 Blue Light Blocker (Ultra)
  • $12 Fashion Gradient
  • $20 Glass Photogrey (Single Vision)
  • $30 Glass Photogrey (Multi-Focal)
  • $55 High Index
  • $12 Ultraviolet Coating
  • $25 Polycarbonate (Single Vision)
  • $30 Polycarbonate (Multi-Focal)
  • $10 Scratch-Resistant Coating (Standard
  • $65 Transitions Single Vision (Standard)
  • $70 Transitions Multi-Focal (Standard)
  • $10 Solid Tint
  • $40 AR Coating – Tier 1
  • $50 AR Coating – Tier 2
  • $65 AR Coating – Tier 3
  • $80 AR Coating – Tier 4
  • 20% discount AR Coating – Tier 5
  • $30 Blended Bifocal (Segment)
  • $39 Retinal Screening
  • $100 Progressive – Tier 3
  • $120 Progressive – Tier 4
  • $140 Progressive – Tier 5
  • $165 Progressive – Tier 6
  • $190 Progressive – Tier 7
  • 20% discount Progressive – Tier 8

For lens options & services purchased from a participating NVA provider, NVA members will only pay the fixed maximum amount or the provider’s wholesale cost, whichever is less. Options not listed will be priced by NVA providers at their wholesale cost. Fixed prices are available in-network only. In certain states, members may be required to pay the full retail amount and not the negotiated discount amount at certain participating providers. Some optometrist affiliated with Optical Retail locations (i.e., Visionworks, etc.) are independent providers and may not participate in the NVA program.

Participating providers are not contractually obligated to offer sale prices in addition to outlined coverage. Regardless of medical or optical necessity, vision benefits are not available more frequently than specified in your policy.

Payments

Your basics, as listed above, are covered by the fund. You pay the optometrist or ophthalmologist for the extras.

How does an eligible person use the NVA Vision Benefits?

NOTE: NVA Vision Benefit may not be coordinated with any other program