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Custom Vision Plan
Eye Examinations
all eye examinations will consist of the following procedures:
- Case History, chief complaint, eye/vision history and medical history
- Distance and near acuities – habitual and/or uncorrected
- External ocular examination
- Internal ocular examination
- Pupillary reflex evaluation
- Tonometry – as appropriate
- Distance refraction – objective and subjective
- Near refraction
- Binocular coordination evaluation – distance and near
- Determination of treatment plan
- Assessment – advice to patient, diagnosis
Ophthalmic Dispensing
if correction is recommended by exam the same location will provide:
- Frame selection – by plan
- Frames shall be shown and advice offered
- Fitting measurements – frame, size, height, etc.
- Ordering from laboratory
- Checking eyeglasses for accuracy
- Adjusting eyeglasses to patient
- Follow-up adjustments for up to three months
Contact Lenses
When chosen in lieu of eyeglasses, contacts lenses will include the following:
- Keratometer measurements
- Biomicroscopic corneal examination
- Fitting with diagnostic lenses
- Provision of lens sterilization kit
- Follow-up examination during fitting period
Ophthalmic Materials
Frames and lenses will be first quality and meet the following standards:
- Lenses will meet the American National Standards Institute (ANSI) standards; ANSI Z-80.1
- Lenses will meet the FDA regulations for impact resistance
- Fabrication of eyeglasses will meet ANSI Z-80.1 tolerance standards
- Frames will meet the ANSI Z-80.5 standards
- Contact lenses meet the ANSI Z-80.8 standards
More Information
CPS can provide your eligible participants with the following optical services for $130.00:
- A comprehensive eye examination, including tonometry, Dilation as professionally indicated
And
- Single vision plastic lenses and a frame, or
- Flat top 25/28 or Executive or Invisible plastic bifocal lenses and a frame, or
- Trifocal 7x28 plastic lenses and a frame. or
- Standard Progressive plastic lenses and a frame, or
- Prescription Sunglasses, or
- Safety Glasses (member only, Single vision or Bifocal)
- Frame will be selected with a retail value of up to $150.00.
- Cosmetic tint, Scratch resistant coating, Ultra Violet coating, Oversize lenses and Polycarbonate lenses for dependents up to age 16 are included at no additional cost
Or
- Two-Week disposable contact lenses (single vision, non-astigmatism, non-cosmetic) a 3-month supply. Exam and Fitting included.
For an eye exam only, the Fund will pay $30.00.
A 30% discount will be given on all non-covered items including a second pair of eyeglasses; excluding frame overages and already discounted, sale, credited or surcharged items.
A credit of $130.00 will be applied to frame upgrades and to the cost of non-covered contact lenses and the fitting.
Patient Surcharges:
| Photosensitive plastic Single Vision lenses | $60.00 |
| Photosensitive plastic Bifocal lenses | $70.00 |
| Photosensitive plastic Multifocal lenses | $80.00 |
| Anti-reflective coating | $45.00 |
| Hi-Index (1.60) | $65.00 |
| Polarized Single Vision | $85.00 |
| Premium Progressives (Varilux Comfort 2 or comparable) | $90.00 |
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