ELIGIBILITY

Persons are eligible if they fall within the eligibility requirements as set by the Contract holder. Eligible dependents include the participant’s lawful spouse and their unmarried children from birth to age 19, or any unmarried children through age 25 who attend an accredited institution on a full-time basis and are entirely dependent on the participant for support.

WAITING PERIOD

Coverage will begin the first of the month following the waiting period as determined by the Contract holder. Once the participant is eligible, the services are available immediately.

PARTICPANT’S REQUIREMENTS

The participant is required to remain in the plan for a minimum of either one year or until such time as the participant becomes ineligible, whichever occurs first.

VISION CARE FACITLITES

In order to receive Plan Benefits, the participant must visit the ASSOCIATED VISION CARE facility which they have selected. The ASSOCIATED VISION CARE facilities have been supplied with a list of all eligible participants and will check eligibility for the Plan Benefits at each appointment.

COORDINATION OF BENEFITS

All other coverages a participant may have will be assigned to the Vision Care Group. Other vision benefits will be considered as “primary” and the AVC Plan as secondary coverage.

TERMINATION

Upon termination of eligibility, Plan Benefits will extend to the end of the month in which termination occurs. Procedures in progress at termination will be completed.

This Highlight Schedule of Vision Care Benefits summarizes many of the provisions of the Associated Vision Care Plan under which services are provided at authorized vision care facilities to eligible participants and their dependents. In cases of discrepancy between this Brochure and the Master Contract, the Master Contract will prevail.

EXCLUSIONS AND LIMITATIONS

Visits to or services performed by a professional not part of the Vision Care Group.

Reimbursement of cost. (The Vision Care Group will bill additional charges directly to the member.)

Any visual services, which, in the judgement of the Vision Care Group, are not reasonable and necessary for the prevention, correction or improvement of a condition.
Services, which are of a degree of complexity that cannot be performed by the contracted professional within the Vision Care Group. Optical services related to fitting or follow up care on bifocal contact lenses.

Vision services not specifically described in the Schedule of Benefits.

Hospitalization, surgery, medications, injury or disease of the eye.

The ASSOCIATED VISION CARE PLAN is not an insurance contract, but merely an agreement between the Contractholder and ASSOCIATED VISION CARE for certain vision and optical services.

This brochure is not a contract. Covered members and dependents will be afforded services according to the terms of the Contract when it is issued.