Medical & Dental

How-to: Finding a POMCO Dentist

OPTUMRx Information
Gym Reimbursement
Enrollment Form
Medical Claim Form
Dental Claim Form
Health Benefit Summary Plan Description 
Dental Benefit Plan Description


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.

GVS Reimbursement Form


  • Comprehensive Eye Examination
  • 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.
    • 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.


  • 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

For any frame over $200, the patient pays the retail price less $200 or less 30%. All other upgrades not listed, the patient pays the retail price less 30%. Members can receive an eye examination from a non-par provider and go in-network to a GVS provider to fulfill prescription.

To comply with the federal Transparency in Coverage Rule, UnitedHealthcare, UMR and HealthSCOPE Benefits creates and publishes the Machine-Readable Files on behalf of the PPSTA Benefit Trust. This link will be active July 1, 2022.

To link to the Machine-Readable Files, please click on the URL provided:

Out of Network Benefits

  • Exam fee: $50
  • Frames only: $100
  • Single Vision only: $50
  • Bifocal/Trifocal Additional: $60
  • Contacts Complete: $150
  • Lasik Surgery: $500.00 per eye
  • Vision Benefits Link

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.

Benefit Trust Coordinator

Debbie Kardas

Office hours: 10:30-1:30 Tuesday, Wednesday & Thursday
Call the PPSTA office @ 845-471-3376