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Poughkeepsie Public School Teachers | GVS
   

General Vision Services

POUGHKEEPSIE PUBLIC SCHOOL TEACHERS Active & Retirees MEMBERS/ACCOUNT 8600/8700

You and your family are are entitled to the following vision benefits once every School year between September 1 and Aug 31:

There is no deductible or co-pays applied when you stay within your POUGHKEEPSIE PUBLIC SCHOOL TEACHERS benefit plan and the GENERAL VISION COLLECTION/NETWORK.

  1. Comprehensive Eye Examination: Included.
  2. Selection of Various Frames: Up to a retail value of $200.00 (Within the GVS Collection).
  3. Selection of lens in plastic:
    • Single Vision
    • Conventional Bifocals
    • Conventional Trifocals
    • GVS Progressives Cosmetic & Rx Sun Tints included.
    • Contacts
    • Standard Soft Spherical Daily Wear
    • Extended Wear Spherical Lenses
    • A 6-month supply (4 boxes) of basic disposables are included. For any other contacts, patient will pay U&C retail less $200.

    The following are special surcharges for services not included in this plan:

    1. AR Coating: $35
    2. Polycarb SV: Included in Rx only
    3. Polycarb FT28: $80
    4. GVS Progressives: $30
    5. Premium Progressives: $70
    6. Varilux Comfort: $120
    7. 1.60 High Index SV: $70
    8. 1.60 High Index FT28: $110
    9. Transitions 3 SV: $80
    10. Transitions 3 FT28: $150
    11. Trans High Index SV: $115
    12. Trans High Index FT 28: $125
    13. Loss/Broken Protection Plan: $25
    14. Is included with a 25.00 co-pay at time of loss for what is covered within your program only if you go to a participating provider.

    Note: Any frame over $200, patient pays U&C retail less $200, less 30%. All other upgrades not listed, patient pays U&C retail less 30%. Members can receive an eye examination from a non-par provider and go in-network to a GVS provider to fulfill prescription.

    Option #2

    Out of Network Benefits

    Members within this group has the option of going out-of-network using the following out-of-network benefits if member is eligible:

    Exam fee: $50

    Frames only: $100

    Single Vision only: $50

    Bifocal/Trifocal Additiona:l $60

    Contacts Complete: $150

    Lasik Surgery: $500.00 per eye

    Note: Benefit will be reimbursed to the member after receiving an authorization number and returning the appropriate claim form and receipts.

    Loss/Broken Protection Plan is included with a 25.00 co-pay at time of loss for what is covered within your program if you go to a participating provider.