EXCLUSIONS AND LIMITATIONS OF BENEFITS This vision service plan is designed to cover visual needs rather than cosmetic materials. If you select any of the following extras, the Plan will pay the basic cost of the allowed lenses, and you will be responsible for the additional cost for the options, unless the extra is defined in the Schedule of Benefits attached as Exhibit A to the Group Plan document maintained by your Group Administrator.

1. Blended lenses
2. Contact lenses (except as noted elsewhere herein)
3. Oversize lenses
4. Photochromic lenses (allowed at no additional charge under Plan C)
5. Tinted lenses except pink #1 or #2 (allowed at no additional charge under Plan C)
6. Progressive multifocal lenses
7. The coating of a lens or lenses
8. The laminating of a lens or lenses
9. A frame that costs more than the plan allowance
10. Cosmetic lenses
11. Optional cosmetic processes
12. UV (ultraviolet) protected lenses

Although a low vision benefit is available to Covered Persons diagnosed as having severe visual problems (i.e., partial sight), it is subject to limitations. Consult your Member Doctor or Benefits Representative for details. There is no benefit for professional services or materials connected with:

1. Orthoptics or vision training and any associated supplemental testing; plano lenses (less than ±.38 diopter power); or two pair of glasses in lieu of bifocals.
2. Replacement of lenses and frames furnished under this Plan which are lost or broken except at the normal intervals when services are otherwise available.
3. Medical or surgical treatment of the eyes.
4. Any eye examination, or any corrective eye wear, required by an employer as a condition of employment.
5. Corrective vision treatment of an experimental nature.

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NAVIGATION

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Introduction | Coverages | Exclusions | Eligibility

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Denver Public Schools
Employee Benefits Department
900 Grant Street, Room 502
Denver, Colorado 80203
(303) 764-3371