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.
- Comprehensive Eye Examination: Included.
- Selection of Various Frames: Up to a retail value of $200.00 (Within the GVS Collection).
- Selection of lens in plastic:
- Single Vision
- Conventional Bifocals
- Conventional Trifocals
- GVS Progressives Cosmetic & Rx Sun Tints included.
- 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:
- AR Coating: $35
- Polycarb SV: Included in Rx only
- Polycarb FT28: $80
- GVS Progressives: $30
- Premium Progressives: $70
- Varilux Comfort: $120
- 1.60 High Index SV: $70
- 1.60 High Index FT28: $110
- Transitions 3 SV: $80
- Transitions 3 FT28: $150
- Trans High Index SV: $115
- Trans High Index FT 28: $125
- Loss/Broken Protection Plan: $25
- 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.
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.