Optical Plan Information


Please find information relating to the Optical Benefits covered under the Buffalo Teachers Federation Supplemental Benefit Fund below. If you have any questions, please contact the Supplemental Benefit Fund Office at (716) 881-5462.

 

WHO IS COVERED?

Under the provisions of the BTF supplemental benefit fund optical plan all members, their spouses and dependents under the age of 23 are covered.

 

WHAT ARE THE BENEFITS?

Covered vision services consist of the care and treatment when performed or prescribed by a physician or a duly licensed optometrist acting within the scope of the license and includes the following:

EYE EXAMINATION

A comprehensive medical examination rendered by a duly licensed physician or a complete vision survey and analysis performed by a duly licensed optometrist.

Teacher Members:    $ 45.00 for one examination in a two (2) year period.
Dependents:              $ 30.00 for one examination in a two (2) year period.

LENSES AND FRAMES

You are now eligible for a first and second service on both Frames and Lenses (which includes contact lenses) in a two (2)-year period. This means that if you are eligible for a first service and purchase just frames, you are still eligible for a first service on lenses (or vice versa).

A two year period begins on the date of your first service (which is the date you order your glasses) and ends two years later. The next two-year period begins when you apply for benefits after the previous two year period has expired.

If you have any doubts concerning your eligibility, call before you purchase your glasses.

 

WHAT IS THE REIMBUREMENT PROCESS?

You are responsible for 100 % payment to the optician. After full payment has been made to the optician, mail the completed claim form to the BTF-SBF office for reimbursement.

Claims submitted for reimbursement must be made within six (6) months of the date of service.

Reimbursement may not be paid for any of the following:

- Services rendered after the date the individual ceases to be covered hereunder.
- Reimbursements requested after 6 months of the date the service was performed.
- Care or treatment rendered, finished or started, prior to the Effective date of your coverage.
 

Optical Extended Benefits


Please find information relating to the Optical Extended Benefits for Cataract, Glaucoma and Diabetes patients below. If you have any questions, please contact the SBF Office at (716) 881-5462.

 

CATARACTS
A physician must verify cataract conditions by submitting a letter, on physician's stationary and signed by the physician, to the SBF Office.
 

PRE‐SURGICAL Cataract Patients

Teachers and their dependents that have been diagnosed as having cataracts, but have not yet had surgery, are eligible for:

- One (1) eye exam every calendar year

 

POST‐SURGICAL Cataract Patients

Teachers and their dependents that have been diagnosed as having cataracts and have had surgery to correct them will begin, from the date the surgery takes place, a new two year reimbursement period, regardless of past optical benefit use.

After the date of surgery has been verified, teachers and their dependents will be eligible for:

- Four (4) pairs of contacts at the SBF 1st service reimbursement rate (currently $90)
- Four (4) pairs of lenses based on the SBF 1st service reimbursement schedule;
- Two (2) pairs of frames based on the SBF 1st service reimbursement schedule (currently $50).
- One (1) eye examination per year within the new two-year period (currently $45).

At the conclusion of the two-year period, normal benefits would resume.

 

GLAUCOMA
A physician must verify the patient has glaucoma by submitting a letter, on the physician's stationary and signed by the physician, to the SBF Office.
 

After the condition has been verified, teachers and their dependents will be eligible every calendar year for:

- Two (2) Glaucoma pressure tests*
- One (1) Visual field test*

Glaucoma sufferers will also be eligible for their normal eye exam once every two (2) years.

* SBF will reimburse each test at the SBF 1st service rate of an Eye Exam (currently $45)

 

DIABETES 
A physician must verify the patient has diabetes by submitting a letter, on the physician's stationary and signed by the physician, to the SBF Office.
 

After the condition has been verified, teachers and their dependents will be eligible every calendar year for:

- One (1) eye examination every calendar year

 

 

Updated 6/27/18

Optical Claim Form


The Supplemental Benefit Fund (SBF) does not participate and will not make payment to anyone except the member of the BTF. Therefore, the member is responsible for 100 % payment to the optician. After full payment has been made to the optician, mail the completed claim form to the BTF-SBF office for reimbursement. If you have any questions, please contact the SBF at (716) 881-5462.

 

Supplemental Benefit Fund Optical Claim Form.

For more information regarding the SBF Optical Benefits, please see the Optical Plan Information Section.

Optical Payment Schedule


Below find the rates of reimbursement for both eligable teacher members and their spouse and dependent children. If you have any questions, please contactthe Supplement Benefit Fund Office at (716) 881-5462.

 

             Teacher Member                    Spouse & Dependents
Eye Examination                   $45.00                   $30.00
                 
    1st Service     2nd Service 1st Service     2nd Service
Frames       $50.00        $40.00       $40.00        $40.00
Single Vision Lenses       $45.00        $35.00       $35.00        $35.00
Bifocal Lenses       $50.00        $35.00       $35.00        $35.00 
Trifocal Lenses       $70.00        $50.00       $50.00        $50.00
Progressive Lenses       $80.00        $55.00       $55.00        $55.00
High Index/Poloycarbinate        $45.00        $30.00       $30.00        $30.00
UV400       $15.00        $12.00       $12.00        $12.00
Anti-Refective Coating       $20.00        $15.00       $15.00        $15.00
Polarized Lenses       $20.00        $16.00       $16.00        $16.00
Transition Lenses       $20.00        $16.00       $16.00        $16.00
Prism Lenses       $5.00        $5.00       $5.00        $5.00

 

THE RATES ABOVE ARE EFFECTIVE ON ALL SERVICES PREFORMED ON OR AFTER JULY 1, 2018

 

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