The Public Employees' Benefits Program (PEBP) offers vision benefits for all participants enrolled in the Self-funded PPO Plan as follows:

Vision Exam: One vision exam every 12 months, or a rolling one year period, paid at 80% of Usual and Customary.

Hardware Allowance: $125 hardware allowance for contacts, lenses and frames every 24 months, or a rolling 2 year period.

You do not need to use a preferred provider and the charge is not subject to an annual deductible or plan co-payments.

To receive reimbursement, click on this claim form link [.PDF format] and print the form. Complete the claim form, attach the itemized bill to the claim form and submit the vision claim to United Medical Resources, Inc. (UMR) (formerly Fiserv Health Plan Administrators). UMR will reimburse you for the expense.

If you have any questions regarding the processing of your claim, please contact UMR customer service at 877-963-8232.