Limitations
This plan is designed to cover your visual needs rather than cosmetic options. Additional Charges You may incur out-of-pocket charges when selecting any of the following: • Tinted Lenses • Photochromic/Polarized Lenses • Polycarbonate (covered under age 19) • Hi-index Lenses • Progressive (available starting at $29) • The coating of the lens or lenses (except Basic Scratch Coating) • A frame that costs more than the plan allowance
• Rimless Frames • Anti-Reflective Additionally, costs for contact lenses/services in excess of the plan’s scheduled reimbursement allowances are the responsibility of the patient. Not Covered The contract gives VBA the right to waive any of the plan limitations if, in the opinion of our optometric consultants, it is necessary for the patient’s welfare. VBA provides no benefit for professional services or materials connected with the following: • Orthoptics or vision training • Non-prescription lenses • Two pair of glasses in lieu of bifocals • Medical or surgical treatment of the eyes • An eye examination, or corrective eyewear, required by an employer as a condition of employment • Services of materials provided as result of any Worker’s Compensation Law or similar legislation • Glasses and contacts during the same eligibility period Lenses and frames furnished under this program which are lost or broken will not be replaced except at the normal intervals when services are otherwise available. Additional Terms and Conditions Frame allowance is based on wholesale pricing at non-retail locations. Frame allowance, contact lens pricing and policies vary by location. Contact your provider before requesting services. Benefits may only be used for contact lenses when selected in lieu of eyeglasses (spectacle lenses and frames). If purchased at the same time from a single provider, your plan will cover up to $110 towards the cost of contact fitting fees and contact lenses. Any provider contact lens charges that exceed this amount shall be the responsibility of the member. Members may be required to pay contact fitting fees out of pocket at some locations. Benefits and participation may vary by location and where prohibited by state law. LASIK benefits may be limited to no more than 50% per eye. A 15% discount off the provider's usual, customary and reasonable contact lens fitting fee may be available in some locations. Void where prohibited by law. Benefits may only be used for medically necessary contact lenses when selected in lieu of all other materials. Additional terms and conditions apply. Contact VBA at 412-881-4900 for more information.
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