SECTION SEVEN:
Vision and Hearing Benefits (Level I)

Vision Care

Routine eye examinations are essential to maintain healthy eyesight. Through Davis Vision, you and your eligible dependents are eligible for annual routine eye examinations and one pair of eyeglasses at no cost, as well as an extra pair of eyeglasses or contact lenses for a small copayment. This is a self-insured benefit — vision benefits are not covered as part of your UnitedHealthcare ‘s Choice Plus coverage.

  • When you contact a Davis Vision provider to make an appointment, the provider will obtain authorization for services. The authorization will be valid for 30 days.
  • You do not need vouchers or ID cards to receive vision care.
  • The Plan provides a discount on Laser Vision Correction services from participating Davis Vision providers.
  • You must receive all services (eye exams, glasses and or contacts) on the same day, from the same network provider.

What You Need To Do:

  • Call the Davis Vision network provider of your choice. You may locate Davis Vision providers on the www.davisvision.com website or call the Davis Vision Voice response unit at (800) 999-5431, or you may contact the Fund Office for a list.
  • Identify yourself as a Teamsters Local 251 Health Services and Insurance Plan member or eligible dependent, and provide the member's Social Security number and the birth date of your eligible dependent that need services.
  • The provider's office will verify your eligibility for services.

Your Vision Benefits

Every twelve (12) months (to the day) you and/or your eligible dependents may receive one of the options listed below when you visit a Davis Vision provider:

 

Vision Service

You Pay

Option One

Eye Exam

No copayment

Option Two

Eye Exam + Eyeglasses

No copayment

Option Three

Eye Exam + Two Pairs of Eyeglasses

$35 copayment

Option Four

Eye Exam + Contact Lenses*

$25 copayment

Option Five

Eye Exam + Eyeglasses + Contact Lenses *

$60 copayment

*You may be responsible for a fitting fee.


Services

Once Every 12 Months
No matter which vision service option you elect, you will not be eligible for another option until 12 months have elapsed

The Fund covers the full cost of lenses and frames included in the Plan's selection. For "non-Plan" frames, you may receive up to $14 toward part of their cost if they are provided in the participating provider's office.
You may receive up to $50 toward the purchase of "non-plan" contact lenses. You are still responsible for the applicable copayments.

Additional Features

In addition to the Plan's standard benefit, you have access to the following lens options, at no charge to you:


  • No Claim Forms

    There are no claim forms for you to fill out when you receive vision care services from a Davis Vision provider. The provider will file your claims for you.
    Scratch Resistant lenses
  • UV coating
  • High index lenses
  • Polycarbonate lenses
  • Polarized lenses
  • Anti-reflective coating
  • Photosensitive lenses
  • Progressive Addition lenses
  • Blended Segment lenses
  • Photochromic lenses
  • Safety eyeglasses (in lieu of regular eyeglasses)

Replacement Contact Lenses

Call Davis Vision at 1 (800) LENS-123 or go to www.lens123.com to purchase discounted replacement contact lenses. The program, Lens 1-2-3, offers guaranteed lowest prices on all name brand contact lenses and solutions. Operators are available seven days a week (Monday through Friday, 8:30 am to 8 pm; Saturday, 8:30 am to 5 pm and Sunday 9 am to 4 pm). Be sure to identify yourself as a Davis Vision Program Participant.

Laser Vision Correction Services

The Plan provides discounts on Laser Vision Correction surgery for you and your family members. You are eligible for discounts of up to 25% off the usual and customary fees or 5% off any advertised fees, whichever is lower. (Some providers have flat fees equivalent to these discounts.) Participating locations are staffed by experienced, credentialed surgeons who use the latest, most advanced instrumentation. For more information, visit the Davis Vision website at www.davisvision.com or call 1-800-999-5431.

Hearing Benefit

The Plan provides hearing benefits such as: screenings, evaluations, hearing aids, and hearing aid consultation for you and your eligible family members when you receive care at the Sargent Rehabilitation Center. The Fund now provides an allowance of $1,000 per aid for digital hearing aids. This is a self-insured benefit — hearing benefits are not covered as part of your Choice Plus. You may be responsible for your plan deductible.

What You Need to Do:

  • Obtain a claim form from the Fund Office
  • Make an appointment by calling (401) 886-6600

All hearing benefits are provided through the Sargent Rehabilitation Center at 800 Quaker Lane, Warwick, Rhode Island 02818. To make an appointment, call (401) 886-6600.

Your Hearing Benefit

You and your eligible dependents are eligible for hearing evaluations every 12 months through the Sargent Rehabilitation Center. A hearing evaluation is a full test by an audiologist to determine your ability to hear sounds and understand speech. If it is determined that you have hearing loss, you may be eligible for a prescribed standard or programmable hearing aid.

Hearing Aid Benefits

If you are prescribed a hearing aid, the following benefits will be provided at no charge to you once every 36 months:

  • Ear molds
  • Hearing aid
  • Fitting supplies
  • Initial supply of batteries
  • Unlimited office visits for one year
  • Related instructions
  • Educational information
  • Programmable hearing instruments

The Fund now provides an allowance of $1,000.00 per aid for digital hearing aids. You are responsible for any remaining balance.
Ear Molds

Children may need more than one fitting for an ear mold. That's why the Plan will cover yearly replacements of ear molds, if necessary through age 18 at no charge to you.

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