Teamsters Local 805 Welfare Fund

SUMMARY PLAN DESCRIPTION -

OPTICAL BENEFITS

The optical plan covers you and each of your eligible dependents for the purchase of up to one pair of prescription lenses and frames every 24 months from last date of service. You may use your own optometrist, or you may go to one of the participating optical centers listed on the following page.

A. VOUCHER

If you go to a participating optical center, you must obtain a voucher from the Fund. The Fund will only issue a voucher if 24 months have passed since the anniversary date you last obtained a pair of glasses from the optometrist.

This card must be used within 30 days from the date the Fund mails it to you.
If you go to a participating optical center, they will take the voucher and bill the Fund directly.

B. NETWORK PROVIDERS

DO NOT PAY the participating optical center anything unless you choose one of the special frames or lenses described below. The optometrist will bill the Fund directly.

If a member does not use the optical card issued within 30 days, the unused card must be returned to the Fund before a new voucher can be issued.

C. NON-NETWORK BENEFIT

If you go to a non-network optometrist, mail in your receipt to the Fund and you will be reimbursed up to $100 for the purchase of lens, frames or contact lenses.

The optical plan does not cover expenses for eye examinations or other additional items such as metal frames, plastic or over-sized lenses, or photosun eyeglasses. If you have an examination, or select special or frames, you must pay the optometrist directly for them.

D. OPTICAL PLAN EXCLUSIONS

In addition to the General Exclusions set forth on page 54, no payment will be made for:

• Medical or surgical treatments;
• Drugs or medications;
• Non-prescription lenses;
• Examinations or materials not listed as a covered service;
• Replacement of lost, stolen, broken, or damaged lenses;
• Services or materials provided by Federal, State, Local Government or Workers’ Compensation;
• Examinations, procedures training or materials not listed;
• Industrial 3(mm) safety lenses and safety frames with side shields.