Optical Extended Benefits

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Extended Optical Benefits for Certain Medical Conditions

The Supplemental Benefit Fund (SBF) offers additional optical benefits for teachers and eligible dependents diagnosed with cataracts, glaucoma, or diabetes. These enhanced benefits are designed to provide additional coverage for the eye care and monitoring that may be needed with these conditions.

 

Glaucoma Benefits

Teachers and eligible dependents with a verified glaucoma diagnosis are eligible for additional testing each calendar year, including:

  • Two glaucoma pressure tests
  • One visual field test

Each test is reimbursed at the SBF first-service eye examination rate, currently up to $50 per test.

In addition to these tests, individuals with glaucoma remain eligible for their regular eye examination once every two years.

Diabetes Benefits

Teachers and eligible dependents with a verified diabetes diagnosis are eligible for one eye examination every calendar year. This enhanced benefit provides more frequent access to routine eye exams to help support the ongoing monitoring of eye health.

Regular SBF optical benefits for frames, lenses, and contacts continue to apply according to the normal benefit schedule.

Verification Required

To receive these extended optical benefits, a signed letter from your physician confirming the diagnosis must be submitted to the SBF Office. The letter must be on the physician’s letterhead.

Optical Claim Form

Use the Optical Claim Form to request reimbursement for eligible eye examinations, frames, lenses, and contact lenses covered under the Supplemental Benefit Fund.

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Cataract Benefits

Pre-Surgical Cataract Benefits

Teachers and eligible dependents who have been diagnosed with cataracts but have not yet undergone surgery are eligible for one eye examination each calendar year.

Post-Surgical Cataract Benefits

Following cataract surgery, a new two-year optical benefit period begins on the date of surgery, regardless of any optical benefits used before the procedure.

During this two-year period, teachers and eligible dependents may receive:

  • Up to four pairs of contact lenses at the SBF first-service reimbursement rate (currently $95 per pair)
  • Up to four pairs of lenses based on the SBF first-service reimbursement schedule
  • Up to two pairs of frames at the SBF first-service reimbursement rate (currently $70 per pair)
  • One eye examination each year (currently reimbursed up to $50)

Once the two-year post-surgical benefit period ends, regular SBF optical benefits resume.