Dental Indemnity
ods-Ddelta
dental
protective dental
Dental PPO
ods-Ddelta
dental
Dental HMO
cigna
delta dental
denticare
pacific dental
liberty dental
Vision Plans
Disability/Life
Vision Service Plan
Available in all 50 states
BENEFIT OUTLINE Prepared For
I.F.P.T.E.
FREQUENCY OF SERVICE |
|
| Examination | Every 12 Months* |
| Lenses | Every 24 Months* |
| Frames | Every 24 Months* |
*Frequency of Service is based on a service year.
Maximum Benefits After Copayment:
| Maximum Reimbursement | ||
| Services From a VSP | for Services from a | |
| Member Doctor | Non-member Doctor | |
| EXAMINATION | Paid in full | $ 40 |
| $10 Copayment | ||
| MATERIALS | ||
| $25 Copayment | ||
| Single Vision Lenses | Paid in full | $ 40 (pair) |
| Bifocal Lenses | Paid in full | $ 60 (pair) |
| Trifocal Lenses | Paid in full | $ 80 (pair) |
| Frame | Standard selection of | $ 45 |
| frames from which | ||
| to choose | ||
| Contact Lenses: (in lieu of lenses and a frame) | ||
| Elective | Up to $105 allowance | Up to $105 allowance |
| for contacts | for contacts | |
| Necessary | Paid in full | $210 |
To obtain a list of VSP member doctors call VSP at 1-800-877-7195, visit their web site at www.vsp.com or you may contact your benefits representative. Contact the VSP member doctor and make an appointment. Identify yourself as a VSP member and provide the doctor’s office with the covered member’s social security number and employer’s name. The member doctor will call VSP to verify your eligibility and plan coverage. If you are not eligible the doctor’s office will call to explain why and discuss available options.
When services are received from a VSP member doctor, reimbursement is made directly to the doctor. The patient will have no out-of-pocket expense other than the copayment, unless optional items are selected that the group does not cover. Optional items include, but are not limited to, oversize lenses, coated lenses, no-line multifocal lenses or a frame that exceeds the wholesale allowance.
If services are obtained from a non-member doctor and/or dispensing optician, the bill is submitted to VSP at: PO Box 997100, Sacramento, CA 95899 and will be reimbursed according to the above schedule. The copayment applies to member and non-member services.
Your Whole Family is Eligible
Union and Associate Members plus their eligible dependents are qualified for plan
benefits. Eligible dependents include your spouse, unmarried children to age age 19,
and full-time students to age 23.
Availability
Vision Service Plan is now available as a stand alone product and available in all 50 states.
Rates! Per pay period (every 2 weeks). Listed separately by type of membership. If you are selecting both a dental plan and Vision Service Plan, the combined rate for both is listed on the dental plan page.
Rates Effective 7/01/2006 through 6/30/2008
| Vision Service Plan | Union Member |
|
| Member | $6.17 | |
| Member + 1 | $8.22 | |
| Member + Children | $8.33 | |
| Member + Family | $11.73 |
Here's how to enroll
- Fill out the Enrollment Application form. Make sure to fill in all the information requested.
- Find the rate above for the dental+vision plan you have selected. Your rate will be on a "Per Pay Period" basis.
- Fill out direct deposit form 1199A. Don't forget to enter the rate you should pay on line G of form 1199A.
- Turn the direct deposit form in to payroll. Mail the application for enrollment form to NWPA from the address listed at the bottom of the page.
Important: It usually takes a few weeks for your payroll deduction to start. Then, we must receive three deductions before your benefits begin. You should allow six to eight weeks for your coverage to become effective.
It's Easy to Pay
By completing the payroll deduction form, your dental premium will be deducted automatically from each pay roll check. You will not be able to use payroll if you already have two other deductions. If this is the case contact NWPA directly to obtain the necessary form. Select the deposit form reflects your type of membership to enlarge its view. Select print from your browser to print the form.
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| Enrollment Form for VSP | IFPTE Member direct deposit form |
Associate Member direct deposit form |