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.
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
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.
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.
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 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
EXCLUSIONS AND LIMITATIONS
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
Vision services not specifically described in the Schedule
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.