Vision Benefits

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All three medical plans offer annual eye exams and eyewear for you and your family. Your vision plan benefits depend on which medical plan you have selected.

If your medical plan is:	Your Vision Care Program is:
Kaiser Permanente HMO	Kaiser Vision (and National Vision Administrators)
Blue Choice HMO	Davis Vision
CareFirst PPO	Davis

National Vision HMO (For Kaiser Enrollees)

If enrolled in the Kaiser Permanente HMO Plan, you can use the Kaiser Vision and National Vision network for vision coverage. Eye exams require a $15 copay. You may also receive discounts on frames and lenses from in-network providers.

Plan Coverage	NVA (included with Kaiser)	DAVIS VISION (included with Blue Choice)	DAVIS VISION (included with CareFirst PPO)
Vision Coverage (Active Employees)	Exams through HMO: $15; discounted lenses and frames through National Vision Administrators (NVA)	Exams through Davis Vision: $15 co-pay Ophthalmologist visits through HMO: $0 co-pay with a referral from PCP; discounted frames and lenses through Davis Vision	Eye exam through Davis Vision: $15 One eye exam per calendar year; discounts on frames, lenses, and contacts when you use a Davis Vision provider
Vision Coverage (Retired Employees)	Exams through HMO: NVA discounts are not available to retired employees and widows	Exams through Davis Vision: $15 co-pay Ophthalmologist visits through HMO: $0 co-pay with a referral from PCP; discounted frames and lenses through Davis Vision	One eye exam per calendar year; discounts on frames, lenses, and contacts when you use a Davis Vision provider
Eye Exams	$15 co-pay	$15 through Davis Vision and $0 through HMO with a referral from PCP	$15 co-pay at participating Davis Vision providers
Frequency	Annually	Annually	Annually
Frames	You select any frame type from a participating provider and pay the wholesale price plus 50%. (You save because the retail price is often three times the wholesale cost.)	Up to $70 retail: You pay $40. Over $70 retail: You pay $40 plus 90% of the amount over $70	Up to $70 retail: You pay $40. Over $70 retail: You pay $40 plus 90% of the amount over $70
Lenses	For example, per the schedule, your cost would be $31/pair for single-vision plastic lenses.	You pay Single: $35 Bifocal: $55 Trifocal: $65	You pay Single: $35 Bifocal: $55 Trifocal: $65

Prescription Safety Glasses

Prescription Safety Glasses for Local 689 members enrolled in Transit Employees Health & Welfare Plan.

If you work in Maintenance or Construction, you are eligible for Safety Glasses. Members are eligible for this benefit once a year.

The primary benefit is offered at no cost to the members. However, members are responsible for extras. For example, Progressive Bifocal is $30; Scratch Resistant Coating is $25; Anti-Glare Coating is $35; Anti-Glare is $40; Black Hard Case is $8.

Please visit www.safevision.net, select a pair of frames from the list below, and send us a copy of your prescription and pupil distance/frame selection for approval to .

SafeVision

Wrap Frames: SV20FS, Battery, Uverse, SV08, Streak, Quantum, Oakleaf

Traditional Frames: SV51, SVSS1, SVSS3, SVSS11, SVSS14, SVSS12.

National Vision HMO (For Kaiser Enrollees)

CareFirst/Davis Vision

Vision Benefit by Comparison

Limitations and Exclusions

Prescription Safety Glasses

Hours of Operation

Resources

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Vision Benefits

National Vision HMO (For Kaiser Enrollees)

CareFirst/Davis Vision

Vision Benefit by Comparison

Limitations and Exclusions

Prescription Safety Glasses

Hours of Operation

Resources

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