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

DescriptionCo-pays
EXAMINATION
Includes TonometryINCLUDED
FRAMES
Up to $200 within GVS CollectionINCLUDED
Non Covered FrameU&C less $200
LENSES
Single VisionINCLUDED
Flat Top (FT28)INCLUDED
TriFocalsINCLUDED
Standard ProgressiveINCLUDED
OversizeINCLUDED
Premium Progressive$50.00 co-pay
Deluxe ProgressiveU&C less 35%
MATERIALS
PlasticINCLUDED
Polycarbonate for children 16 and under includedU&C less 35%
PolycarbonateU&C less 35%
COATINGS
Cosmetic or Sunglass TintINCLUDED
Ultra Violet CoatingU&C less 35%
Scratch Resistant CoatingU&C less 35%
Anti-reflective Standard CoatingU&C less 35%
Anti-reflective Premium CoatingU&C less 35%
CONTACTS
Colored Contact Lenses are NOT included
Fitting and Dispensing Included for the following LensesINCLUDED
Spherical Disposables- 12 months supplyINCLUDED
Non Covered Contact LensesU&C less $200
Fitting Fee for Upgraded Lenses$50.00 co-pay
 

LENS BENEFITS CO-PAYS

MATERIALS/HI-INDEX LENSES
Hi-Index Single VisionU&C less 35%
PLASTIC PHOTOSENSITIVE LENSES
Plastic Photosensitive Single VisionU&C less 35%
Plastic Photosensitive BifocalU&C less 35%
PolarizedU&C less 35%

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.
Updated: 03/28/2024