Did You Know?
Generally, expenses claimed under the Vision Care Benefit are subject to a two-year eligibility cycle that begins every odd year, meaning that the stated maximum eligible expense is for two calendar years instead of one. A new cycle began in 2023, and the next will begin in 2025.
The Vision Care Benefit provides 80% reimbursement for the reasonable and customary charges of the following expenses based on this two-year cycle:
Eligible expenses with two-year cycle
Eye examinations by an optometrist, limited to one examination every two calendar years, commencing every odd year.
Eyeglasses and contact lenses that are necessary for the correction of vision and are prescribed by an ophthalmologist or optometrist, and repairs to them, limited to a maximum eligible expense of $400 every two calendar years, commencing every odd year
If $275 of prescription eyeglasses or contact lens claims were incurred before July 1, 2023, an additional $125 can be claimed for purchases/ repairs incurred on or after July 1, 2023
Starting January 1, 2025, prescription eyeglasses or contact lenses can be claimed up to $400 every two years.
Eligible expenses where two-year cycle does not apply
Artificial eyes and replacements thereof, but not within:
- 60 months of the last purchase in the case of a member or dependant over 21 years of age, or
- 12 months of the last purchase in the case of a dependant 21 years of age or less,
unless medically proven that growth or shrinkage of surrounding tissue requires replacement of the existing prosthesis.
The initial purchase of intraocular lenses, eyeglasses, or contact lenses necessary for the correction of vision and required as a direct result of surgery or an accident where the purchase is made within six months of such accident or surgery.
This benefit is not subject to any limits other than reasonable and customary charges.
The six-month time limit may be extended if, as determined by the Administrator, the purchase could not have been made within the time frame specified.
Lifetime maximum of $2,000 per plan participant.
Surgery must be performed by an ophthalmologist. A physician’s prescription is not required.
Expenses incurred for cataract surgery are not eligible under this benefit.
If $1,000 for laser eye surgery was incurred before July 1, 2023, an additional $1,000 can be claimed for services incurred on or after July 1, 2023
Exclusions
No benefit is payable for:
- Eye-related procedures which use lasers but where the laser does not reshape the cornea with the goal of correcting common vision problems
- Expenses identified in the General Exclusions and Limitations of the Plan