The following chart lists the services and supplies covered under the vision benefit for the Trooper Chapter, Airport Police and Fire Officers Chapter, Fairbanks Police Department, Fairbanks Fire Department and Juneau Police Department members, as of July 1, 2009. Refer to your Benefit Booklet for details, general limitations and exclusions.
Examinations
Plan pays 80% of allowable charges; one routine vision examination per person each calendar year including:
Examination of the outer and inner parts of the eye
Evaluation of vision sharpness (refraction)
Binocular balance testing
Routine tests of color vision, peripheral vision and intraocular pressure
Hardware
Plan pays 80% of allowable charges for the following, limited to one pair of lenses per calendar year and one set of frames each two consecutive calendar years:
Prescription eyeglass lenses (single vision, bifocal, trifocal, quadrafocal or lenticular)
Frames for eyeglasses
Prescription contact lenses (soft, hard or disposable)
Prescription safety glasses
Prescription Sunglasses
Special features such as tinting or coating
Fitting of eyeglass lenses to frame
Fitting of contact lenses to the eye
Contact Information
Premera Blue Cross Blue Shield of Alaska P.O. Box 91059
Seattle, WA 98111-9159
Local and toll-free: 1-800-508-4722
Hearing-impaired TTY:1-800-842-5357
