Optical Benefit

Optical Benefit Providers

Optical Benefit Brochure

ELIGIBILITY

Covered members, retirees on a self-pay plan and their enrolled dependents are entitled to optical benefits once during each plan year (September 1 to August 31). Retired members in the Basic Plan are eligible once every two years. 

THE BENEFIT

You have the option of choosing from either one or two the following optical benefits under this program.

  1. At participating providers, you are entitled to a paid-in-full benefit for a comprehensive eye exam including glaucoma test and one pair of eyeglasses or prescription sunglasses (lenses and frame), or the benefit may be used for standard daily wear, disposable contact lenses or planned replacement contact lenses. Additional frame selections and many different lenses and coatings are also available at participating providers at discounted prices. Contact the Fund Office or check the Fund website for a recent list of copays. 

    All frames and lenses through participating providers have a one year 100% replacement guarantee if damaged or broken due to defects in manufacturing.
  2. At nonparticipating providers, reimbursement will be made directly to you for actual expenses not to exceed $10 for an exam and up to $35 for materials (frames, lenses, contacts). 1 2

1 If you choose to use a nonparticipating provider, return your Direct Reimbursement Claim Form, with receipts attached (applicable to active members, enrolled dependents, and retirees purchasing the Enhanced Plan only) to the Fund’s optical benefit administrator at the address on the claim form. Reimbursement will be made directly to you within the Fund’s schedule of benefits payable for covered services noted in 2 above.

2 Retirees enrolled in the Enhanced Plan are eligible for up to $150 in reimbursement for covered optical services received by an out-of-network provider located outside of New York State.

GENERAL LIMITATIONS

  • When you go to a nonparticipating provider, you must have the provider complete the Direct Reimbursement Claim Form. The examination, lenses, and frames must be billed at the same time, on one claim form during each plan year (September 1 to August 31).
  • In order for you to make the best possible use of your optical benefit, please keep in mind that partial usage of the benefit is considered the same as full usage. If, for example, you file a claim for an eye examination only or just for the repair of frames, you will not be entitled to receive the benefit for another Plan year.
  • The three parts of the benefit (examination, lenses, and frame) cannot be split between participating providers and nonparticipating providers. You must use one option or the other for all three parts.

OBTAINING THE BENEFIT

Call the Fund Office or check the Fund website for a list of participating providers or for a Direct Reimbursement Claim form if you use a nonparticipating provider. 

In order for a dependent full-time student between the ages of 19 and 25 to obtain optical benefits, proof of full-time student status must be submitted every semester. Verification of student status forms may be obtained at the Fund Office.

If you choose a participating provider, call the provider’s office directly to schedule an appointment. Identify yourself as an FA Benefit Fund member or dependent. The provider’s office will verify your eligibility for services.