VISION CARE PLANS WITH YOU IN SIGHT

The UAW-Ford Vision Care Program provides members with comprehensive vision care services. If you are enrolled in the Traditional Plan for health care coverage, a PPO or HMO plan that does not provide vision care coverage, Single Vision Solution, Inc. administers your vision care program. A network panel consisting of SVS Vision Optical Centers and other affiliated providers fulfill the eye exam and eyewear services.

To receive the largest benefit, members living within 25 miles of a network provider can schedule an appointment and select their eyewear at any SVS Vision Optical Center or affiliated provider location.

If you live more than 25 miles from an affiliated provider or choose to receive vision care services from a non-Network provider you will receive reimbursement for benefits, according to your plan schedule, by submitting an application for benefits form.

What does my UAW-Ford Vision Plan Cover?

Services

Network Provider

Non-Network Provider (Live over 25 miles from Network Provider) Reimbursement

Non-Network Provider (Live within 25 miles of Network Provider) Reimbursement

Frequency of Coverage*

Eye Exam

Full Coverage

$45.00

0

12 Months

Re-examination (by an Ophthalmologist)

$45.00

$45.00

0

12 months when medically necessary*

Lenses (Glass or Plastic):

24 months

Single Vision

Full Coverage

$59.00

$13.00

Bifocal

Full Coverage

$79.00

$13.00

Trifocal

Full Coverage

$99.00

$13.00

Special (lenticular, aspheric, etc.)

Full Coverage

$99.00

$13.00

Lens Options:

Tints equal to Rose 1 or 2

Full coverage

0

0

Scratch Resistant coating for age 13 and under

Full coverage

0

0

Oversized lenses

Full coverage

0

0

Frames

24 months

Standard Frames

Full Coverage

$49.00

$13.00

Designer Frames

$40.00

$49.00

$13.00

Contact Lenses (instead of eyeglasses)

24 months

Not medically necessary

$75.00

$89.00

$37.00

Professional fees (fitting/follow-up)

$40.00

Included above

Included above

Medically necessary to achieve 20/70 in better eye or for keratoconus, irregular astigmatism or irregular corneal curvature as diagnosed by M.D. or O.D. including professional fees and contact lenses

Up to $350.00

$200.00

$52.50

* Refer to your benefit brochure for complete details, special circumstances, and program exclusions

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