GUIDELINES FOR EYEGLASS REIMBURSEMENT

(Voted on at the 12/12/2012 Executive Board Meeting)

  THE BENEFIT:

ONE Reimbursement– Up to a $25 out of pocket expense for corrective lenses (contacts or glasses), Per calendar year per member and *dependent(s).

*Dependent =    Must be listed on the dependent form at the Union office.

1. Married spouse
2. Unmarried biological and/or legally adopted children
   1. (Up to the age of 18 years old - unless in college)
      • Dependents in college – Up to their first bachelor’s degree
        • Must include a form of proof such as a bill,  

                               current semester schedule, or a copy of their school ID.

EYE EXAMS ARE NOT COVERED

CO-PAYS ARE NOT COVERED

MEMBERS MUST:

• Be in good standing
• Have a benefits form on file which includes the person’s name on the receipt, if not, the benefit will be denied and the member will have to complete benefit cards

THE RECEIPT MUST:

•  Be submitted along with the eyeglass reimbursement form

•  Have the Member name AND the name of the patient on it
•  Include date of purchase not more than 6 months old
•  Receipts older than 6 months from date of purchase will be denied
•  Show the purchase of corrective lenses in the form of contacts or glasses

     OTHER INFORMATION:

•  Eyeglass Reimbursements are processed every four to six weeks
•  Checks will be written to the member
•  Checks not cashed within 60 days will be voided and will not be reissued
•  Benefits cease once the member retires or passes away

Eyeglass Reimbursement Form.pdf

Eyeglass Reimbursement Form.doc