Vision Care
What Is Not Covered

Your vision care benefit does not cover the following:

• Orthoptics or vision training
• Two pair of glasses in lieu of bifocals
• Services or materials provided as a result of any Workers' Compensation Law (or similar legislation)
• Replacement of lost or broken lenses or frames provided under this plan other than the normal intervals when services are otherwise available
• Non-prescription lenses
• Medical or surgical treatment of the eyes
• Any eye examination, or corrective eyewear, required by an employer as a condition of employment
• Glasses and contact lenses during the same eligibility period (once in 12 months)
• High index lenses

If you use a NVA-participating provider, but do not provide the NVA benefit form on your first visit, your vision care services may not be covered under NVA's higher level of benefits for using network providers. In this instance, the NVA-participating provider may elect to charge his or her UCR fees.*

* The UCR (usual, customary and reasonable) fee is charged by other providers in a specific geographic area.

Copyright ©2006-2010 Valley Forge Benefits Consulting, Inc.