Eye Care
Provider

PLATINUM-12

Robert Rauff with the Staff from Davis Vision of Plainview

Dear Fund Member:

Danny Donohue
is president of the 265,000 member
CSEA – New York’s leading union.

The Platinum-12 Vision Care Plan offers quality eye care services at no cost to members from one of the Plan's panel providers.

EBF Local Government Vision Plans

All of the following EBF Vision Plans are available on either a 12 or 24 month benefit basis.

**Please Note: The Sliver Plan and Gold Plan are Crossed out Because they are not Part of the Local 881 package. But I wanted to include them for informational purposes, but striked out to remind members that they do not apply to our plan.)

Silver

The Silver Vision Plan entitles members and their eligible dependents to an eye exam and a pair of either Lenses and Frames or Soft Daily-Wear Contact Lenses once every 12/24 months. Members using participating Optometric providers pay no out of pocket expenses provided they stay within the Plan Lens and Frame Bars. For the Silver Plan, the Lens Bar covers Single Vision Lenses, Bi and Trifocals as well as Prescription Sunglasses and Cataract Lenses. The Frame Bar consists of approximately 300 frames in various designer styles and colors including Wire and Spring-Hinge Frames. Members using a non-participating provider are reimbursed based on the fee schedule appearing in the Summary Plan Description provided to the member.

Gold

The Gold Vision Plan, with the exception of two areas works the same as the Silver Plan. These two exceptions occur when a member uses a non-plan provider for Specialty Contact Lenses not covered by EBF plans (i.e., Hard, Extended Wear, Gas Permeable) or when an employee may require an occupational vision exam. Under the Gold Plan, members wearing Specialty Contact Lenses would receive a $125.00 allowance (up from $75.00 in Silver) towards the cost of the lenses. For the Occupational Benefit, the Gold plan entitles the member to an occupational eye exam, which may result in the member being prescribed two pair of glasses, one for "daily wear" and the other to be used at work. The prescription must be different than the "daily wear" pair or include a tint. The Provider would make the determination whether the second Occupational pair is warranted. The Occupational exam and the regular exam are covered under the same voucher and must be performed by a Participating Plan Provider.

Platinum

(This is the Plan Local 881 Members Enjoy)

The Platinum Vision Plan again works similar to the Silver Plan with some additions. The Lenses Bar is expanded to include standard Progressive No-Line Bi and Trifocals as well as Glass Photochromic lenses and Scratch Proofing. The $125.00 Specialty Contact Lenses allowance from the Gold Plan is also carried over. Platinum also offers the Premier Frame Line, which includes more Designer, Wire and Rimless Frames for the members to choose from. There is no Occupational Benefit included as in the Gold Plan, but it can be added as an Option with this Plan.
Vision Plan Options

The following Vision Plan Options can be added to the Optical programs offered by the EBF. Please note that some options are not available for all plans.

Anti-Reflective Coating

A coating which allows a much higher percentage of light to pass through the lens. The increased transmittance of light reduces virtually all annoying, unattractive reflections that can hinder your vision. In addition, lenses appear crystal clear and nearly invisible due to the elimination of reflected light. Reflection free coating improves the look, comfort, and optical clarity. May be purchased separately under the Silver, Gold and Platinum Plans.

High Index Lenses

Plastic or polycarbonate lenses which are 20-25% thinner and lighter than conventional lenses. High Index lenses are much thinner, more attractive and their lighter weight makes them more comfortable to wear. May be purchased separately under the Silver, Gold and Platinum Plans.

Polaroid Lenses

Two lenses laminated together which effectively block glare; especially useful near water or snow. May be purchased separately under the Gold and Platinum Plans.
Premium Progressive Addition Lenses
Includes name brand progressive lenses such as Varilux, Rodenstock and Kodak not covered by the Platinum Plan standard benefit. The invisible bifocals provide a full range of vision from distance to intermediate to near focal points. May be purchased separtately under the Platinum Plan.

Scratch Resistant Coating

A coating applied to plastic lenses to help prevent scratching. Scratch resistant coating will help glasses wear longer and look better. This option is included in the Platinum Plan and may be purchased separately under the Silver and Gold Plans.

Transition Lenses

A plastic lens which gradually darkens to sunlight to provide comfort and convenience. May be purchased separately under the Platinum Plan.

Ultra Violet Coating

A coating applied to plastic lenses to block up to 99% of damaging UV rays via exposure to the sun, TV, video and computer screens. May be purchased separately under the Silver, Gold and Platinum Plans.

VDT/Occupational Vision

Members (not available for spouses or dependents) whose job duties require 50% or more of their work hours either on a video display terminal or driving a vehicle will be examined and a determination made, which may warrant a different prescription and an additional pair of glasses. Drivers will be entitled to a prescription pair of sunglasses even if the prescription is the same as their regular glasses. This option is included in the Gold Plan and may be purchased separately under the Platinum Plan.

BENEFIT PROVISIONS

Eligible members (and dependents, if covered) are entitled to an eye examination and one pair of glasses (lenses and frames), including progressive no-line bifocals or trifocals, photo-chromic lenses, and scratch proofing.
OR soft daily wear contact lenses.

USING THIS BENEFIT

Great News!! As of 2001 Members no longer need to Call to receive a voucher. Just make an appointment with a Vision Care Panel Practitioner and they will notify you of the next available time you may receive services.

To call the Employee Benefit Fund (toll free):

1-800-EBF-CSEA

The CSEA lens selection includes almost every type: plastic or glass, bifocals, trifocals, cataract lenses, fashion tints and prescription sunglasses. The Frame Collection includes designer styles and wire frames as well as the Premier Line found exclusively in the Platinum Plan. Selections not included in the CSEA Frame Collection will require the employee to cover the excess amount over the Benefit Fund allowance.
If Plan contact lenses are chosen, there is no out-of-pocket expense to the member

ELIGIBILITY

You are eligible if your local or unit has negotiated
this benefit and elected to participate in the Fund. Your eligibility is determined by the terms and conditions set forth in your collective bargaining agreement.

DEPENDENTS

Are eligible if so designated in your collective bargaining agreement to include:
o Your spouse, provided he or she is not legally separated from you.
o Your unmarried children, including stepchildren who permanently reside with you and legally adopted children, under the age of 19.
o Your legal ward under the age of 19 who permanently resides with you pursuant to a court order awarding legal guardianship to you.
o Any child or ward described above, regardless of age, who is incapable of self-support by reason of mental or physical disability, provided he or she became so disabled prior to reaching the age of 19.
o Any child or ward described above under the age of 25 who is a full-time student (minimum of 12 undergraduate or 6 graduate credit hours) enrolled in a regionally accredited college or university and working toward a Bachelors Degree (e.g., B.A. or B.S.), Master's Degree (e.g., M.A. or M.S.) or Associate's Degree (e.g., A.A. or A.S.). Technical courses of short duration do not qualify, even if a diploma is awarded. The Fund requires that current proof of student status be provided annually (letter or statement from the registrar's office of the college or completion of Student Status Form available from the Fund).
This form is used only to update/validate the CSEA EBF dependent student eligibility file. Your Health Insurance not be covered both as an employee and as a dependent of an employee. If both parents are Fund members, coverage for children may not be claimed under both parents.
ENROLLMENT carrier may require different or additional evidence of dependent student enrollment. We suggest that you obtain a letter of student enrollment from the school registrar to avoid delays in processing health insurance claims for your child.

NOTE: An employee may not be covered as an employee and as a dependent of an employee. If both parents are Fund Members, coverage may not be claimed under both parents.

Enrollment

Coverage under the Plans offered by the CSEA Employee Benefit Fund is not automatic. You must first enroll yourself and your dependents (if covered). There is one enrollment card which enrolls you in the plan(s) negotiated for you. Enrollment cards are available by contacting the Fund at 1-800-EBF-CSEA.
Enrollment in the plan does not vest any right in the covered employee except the right to receive benefits under the plan only so long as payments are being received by the Fund on behalf of the employee.

C.O.B.R.A.

If you become ineligible for Fund coverage because of retirement, termination, layoff, leave without pay or reduction in hours, you may have certain rights to continue Plan coverage through C.O.B.R.A. Under these and certain additional circumstances, your spouse and/or dependent(s) may have rights to continue coverage through C.O.B.R.A. as well.
Before your payroll status changes, ask your employer for details about continuing coverage through C.O.B.R.A.

APPEAL PROCEDURE

If you feel that you did not receive full benefits, you may appeal to the Director of the Fund.
Send a letter to the Director explaining why you feel you did not get the full amount to which you were entitled. Include copies of any supporting documentation.
This procedure is not designed to cover clerical mistakes on claims, which may be corrected by a phone call to the Fund. Nor is it meant for services clearly not covered by the Plans.