Davis Vision

P.O. Box # 1525
Latham, NY 12110
1-800-999-5431



or

Raymond Opticians

Visit their web site for for various locations throughout Westchester, Putnam & Dutchess Counties 
Members have the choice of continuing to use Davis Vision OR Raymond Opticians. You may utilize the services of only ONE of these providers in a plan year (July1 - June 30).

Who Is Covered?
  • Enrolled members are covered for the Optical Benefit Plan.
  • Enrolled members may assign their benefits over to another family member by filling out the Vision Benefit Assignment Form. This form must be brought with you to your vision provider.
What Benefits Are Paid?
Under the MTABF Optical Benefit you can receive the following on a yearly basis:
  1. Eye examination
  2. Glasses OR contacts
  3. Raymond offers a free spare pair of eyeglasses or prescription sunglasses. Raymond will allow you 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.
  4. Additional $100.00 OPTICAL REIMBURSEMENT:

Members may also utilize the reimbursement plan which, in addition to the above coverage, pays a benefit allowance of up to $100 once every plan year (July 1 through June 30) for each covered member for services rendered by an optometrist or ophthalmologist of his/her choice towards an eye examination, prescription lenses, and/or frames or contacts. If a member uses a participating provider and selects frames and lenses outside of those offered by Davis or Raymond, a claim form may be submitted to Preferred Group Plans to defray up to $100 of additional costs. Dependents are NOT eligible for this benefit.

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 by a member of your or your spouse's immediate family are NOT covered.
To Receive the $100.00 Optical Reimbursement:
  1. Fill out a Claim Form.
  2. Return the completed claim form to the address below together with an original, dated receipt marked "paid" describing the type of service rendered, the date service was rendered, the amount charged and name of the person who received the optical service.
  3. If a member uses a participating provider and selects frames and lenses outside of those offered by the Davis Plan, a claim form may be submitted to Preferred Group Plans to defray up to $100 of additional costs.
  4. Completed claim forms should be mailed to:
                   MTA Benefit Fund
                   c/o Administrative Services Only, Inc.
                   P.O. Box 9005
                   Lynbrook, NY 11563

If you choose DAVIS:

1)  Fill out & send Vision Enrollment Form to:
MTA Benefit Fund
c/o Administrative Services Only, Inc.
P.O. Box 9005
Lynbrook, NY 11563
(This form needs to be filled out one time only.)

2)  Enrolled members may assign their benefits over to another family member by filling out the Vision Benefit Assignment Form. This form must be brought with you to your vision provider.

3)  Under the no-cost option, you simply contact Davis Optical directly at 1-800-999-5431 or at the Davis Web Site. (When using the Davis Web Site your member number is your social security number.) Davis will provide a list of participating provider locations and optical voucher. Please contact Davis Optical directly.

If you choose Raymond:

1)  Fill out & send Vision Enrollment Form to:
MTA Benefit Fund
c/o Administrative Services Only, Inc.
P.O. Box 9005
Lynbrook, NY 11563
(This form needs to be filled out one time only.)

2)  Enrolled members may assign their benefits over to another family member by filling out the Vision Benefit Assignment Form. This form must be brought with you to your vision provider. 

3)  Under the no-cost option, you simply contact your local Raymond Office (visit the Raymond Web Site for for various locations throughout Westchester, Putnam & Dutchess Counties). Raymond will provide you with an appointment. Please contact Raymond Opticians directly.

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