Benefits

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

Vision

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

Benefits

• 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.

Surcharges:

• 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: https://transparency-in-coverage.uhc.com/