Raymond OpticiansVisit the Raymond Opticians Website for various locations throughout Dutchess, Putnam & Westchester.
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OPTICAL Provider of Your ChoiceSelect a provider of your own choosing &
you submit the claim for reimbursement. |
Who Is Covered?
The optical benefit may be utilized by the eligible covered member OR one eligible enrolled dependent/ spouse, one time in a plan year (July 1 through June 30). What Optical Benefits Are Covered & How Much is Reimbursed?
Under the MTABF Optical Benefit eligible members OR one eligible enrolled dependent/ spouse can receive reimbursement for one of the following on an annual basis: Raymond offers a free spare pair of eyeglasses or prescription sunglasses.
Raymond will allow members to transfer this benefit to a family member. (In order to transfer this benefit you must bring in the family members current prescription.) See a Raymond Optician for details. |
Limitations & Exclusions to this benefit:
- Charges in excess of the above allowances are the responsibility of the member.
- Non-prescription sunglasses are NOT covered.
- Services provided to a member who are not of your or your spouse's immediate family are NOT covered.
Additional $100.00 Optical Reimbursement:
- In addition to the above coverage, the MTABF pays an allowance of up to $100 once every plan year for the eligible member OR for ONE of the eligible member's dependent/spouse.
- The benefit covers services rendered by an optometrist or ophthalmologist of choice towards an eye examination, prescription lenses, frames and/or contacts.
To Receive the Optical Reimbursement:
c/o Administrative Services Only, Inc.
P.O. Box 9005
Lynbrook, NY 11563
- Fill out a Optical Claim Form. (Raymond Vison will do this for you.)
- Return the completed claim form to the address below together with an original, dated receipt, a description of the type of service rendered, the date service was rendered, the amount charged and name of the person who received the optical service.
- Completed claim forms should be mailed to:
c/o Administrative Services Only, Inc.
P.O. Box 9005
Lynbrook, NY 11563