ARTICLE IV - VISION CARE
Section 1 - Establishment and Effective Date
The railroads will establish a Vision Care Plan to provide specified vision care benefits to employees and their dependents, to become effective January 1, 1999 and to continue thereafter subject to provisions of the Railway Labor Act, as amended, according to the following provisions:
(a) Eligibility and Coverage. Employees and their dependents will be eligible for coverage under the Plan beginning on the first day of the calendar month after the employee has completed a year of service for a participating railroad, but no earlier than the first day of January 1999. An eligible employee who renders compensated service on, or receives vacation pay for, an aggregate of at least seven (7) calendar days in a calendar month will be covered under the Plan, along with his eligible dependents, during the immediately succeeding calendar month. Any calendar day on which an employee assigned to an extra list is available for service but does not perform service shall be deemed a day of compensated service solely for purposes of this Section.
(b) Managed Care. Managed vision care networks that meet standards developed by the National Carriers' Conference Committee concerning quality of care, access to providers and cost effectiveness shall be established wherever feasible. Employees who live in a geographical area where a managed vision care network has been established will be enrolled in the network along with their covered dependents. Employees enrolled in a managed vision care network will have a point-of-service option allowing them to choose an out-of-network provider to perform any vision care service covered by the Plan that they need. The benefits provided by. the Plan when services are performed by in-network providers will be greater than the benefits provided by the Plan when the services are performed by providers who are not in-network providers, including providers in geographic areas where a managed vision care network has not been established. These two sets of benefits will be as described in the table below.
| Plan Benefit | In-Network | Other Than In-Network |
|
One vision examination per 12-month period. |
100% of reasonable and customary charges |
100% of reasonable and customary charges up to a $35 maximum |
|
One set of frames of any kind per 24-month period |
100% of reasonable and customary charges1 | 100% of reasonable and customary charges up to a $35 maximum |
| One set of two lenses of any kind, including contact lenses, per 24-month period. | 100% of reasonable and customary charges2 | 100% of reasonable and customary
charges up to the following maximums:
up to $25 for single vision lenses up to $40 for bifocals up to $55 for trifocals up to $80 for lenticulars up to $210 for medically necessary contact lenses up to $105 for contact lenses that are not medically necessary |
| Where the employee or dependent requires only one lens | 100% of reasonable and customary charges 2/ | 100% of reasonable and customary charges up to a maximum of one-half of the maximum benefit payable for a set of two lenses of the same kind |
1 Patients who select frames that exceed a wholesale allowance established under the program may be required to pay part of the cost of the frames selected.
2 Patients may be required to pay part of the cost of spectacle lenses or lens characteristics that are not necessary for the patient's visual welfare. Moreover, patients who choose contact lenses in lieu of spectacles may be required to pay part of a contact lens evaluation fee and part of the cost of fitting and materials.
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Section 2 - Administration
The Vision Care Plan will be administered by the National Carriers' Conference Committee, which will bear the same responsibilities and perform the same functions as it does with respect to The Railroad Employees National Dental Plan, including the development of detailed plan language describing the Plan's eligibility, coverage, benefit and other provisions.