6883 UFCW LOCAL 1500 WELFARE FUND

Below you will find your Full Benefits Summary including your Vision Benefits, Enhanced Benefits, and Bonus Benefits. Please print this document and bring it with you to your appointment. If you need any assistance, please call 1-855-653-0586.

VISION BENEFITS SUMMARY Description Co-pays EXAMINATION Includes Tonometry INCLUDED FRAMES Non-Collection Frame Allowance (In Lieu of Collection Frame) U&C less $250 GVS Collection - Classic INCLUDED GVS Collection - Metropolitan INCLUDED GVS Collection - Premier INCLUDED LENSES Single Vision Lenses INCLUDED Bifocal Lenses (FT28) INCLUDED Trifocal Lenses INCLUDED Standard Progressives INCLUDED Oversize INCLUDED Premium Progressives $50.00 co-pay Deluxe Progressives $80.00 co-pay GVS Progressive INCLUDED MATERIALS Plastic INCLUDED Polycarbonate for dependent children (up to age 16) INCLUDED Polycarbonate- Single Vision Lenses INCLUDED COATINGS Cosmetic or Sunglass Tint INCLUDED Ultra Violet INCLUDED Scratch Resistant Coating INCLUDED Anti-Reflective - Standard Coating INCLUDED Anti-Reflective - Premium Coating $90.00 co-pay CONTACTS Colored Contact Lenses are NOT included Fitting and Dispensing Included for the following Lenses INCLUDED Spherical Disposables- 12 months supply INCLUDED Non Covered Contact Lenses U&C less $250 Fitting Fee for Upgraded Lenses $50.00 co-pay   LENS BENEFITS CO-PAYS MATERIALS/HI-INDEX LENSES Hi-Index Single Vision $55.00 co-pay PLASTIC PHOTOSENSITIVE LENSES Plastic Photosensitive - Single Vision Lenses $50.00 co-pay Plastic Photosensitive - Bifocal Lenses $95.00 co-pay Polarized $75.00 co-pay

Please make an appointment. Doctors hours may vary from store hours.

For Florida locations, eye exams may have a co-pay.

Any additional services that surpass the benefit are the responsibility of the patient.

30% Discount on all optical services not listed above, including 2nd pairs.

Updated: 07/15/2025