The following client details apply to RTX members only. Please refer to the Patient Record Report to confirm coordination or benefits restriction applies.

The following client details apply to RTX Corporation members only. Please refer to the VSP Safety Eyecare Plan in the Plans and Coverages section for complete Safety Eyecare information for these members.

Before scheduling an appointment, RTX members must get a signed “RTX ProTec Eyewear Authorization Form” from RTX. Although not required, RTX members may also present the VSP Safety Requirements Questionnaire at the time of their exam. Please put all applicable forms in the patient’s file.

There are two ways to get authorization:

• Online: Log on to eyefinity.com, select Get Authorization & Check Eligibility, and then select Member Search.
• By phone: Call VSP at 800.615.1883. You’ll need to provide the name of the Raytheon supervisor who approved the benefit to our Customer Service Representative to get an authorization.

Copay

Exam – No co pay.

Materials – No copay.

Under the ProTec Safety Plan, RTX members are eligible for a fully covered safety frame from the ProTec Eyewear^® frame kit and single-vision, lined bifocal, or trifocal polycarbonate lenses. Detachable side shields and a frame case are provided with each order through the participating labs.

The following limitations and requirements apply to RTX members:

• Safety glasses are available to the employee only.
• Polycarbonate lenses are preferred and covered.
• Permanent or removable side shields are required for all frames and are covered for ProTec Eyewear frames.
• If permanent side shields are required, it will be noted on the member’s RTX Technologies ProTec Eyewear Authorization form. Note: When billing on eyefinity.com enter “permanent side shields” in Lab Special Instructions on Invoice Services page of eClaim.
• All ProTec Safety and Repair/Replace orders must be sent to participating labs.
• Frames for electricians must be made from non-metallic materials.

Repair/Replace Benefits

RTX employees must provide a signed “RTX Safety Eyewear Authorization Form” before they can receive repair/replacement safety services or materials.

After using their materials benefit under their ProTec Safety plan, RTX members have an additional Repair/Replace benefit for their safety eyewear which covers materials.

• RTX members are eligible for repair/replacement if their spectacle lenses or frames are broken or damaged.
• Eligible RTX members covered under this additional benefit are entitled to safety eyeglass lens and safety frame repair/replacement.
• Frame repair includes temples only, front only, hinge, and miscellaneous repairs.
• The repair benefit may also include replacement of a complete frame and/or basic lens based on your professional judgment.

The following limitations and requirements apply to RTX members:

• For RTX members that supply a non-ProTec Eyewear frame to have lenses replaced, order must be sent to participating labs.
• For RTX members that supply a non-ProTec Eyewear frame for repair/replacement, previous safety frame must be replaced with a selected ProTec Eyewear model.
• For new frames, RTX members must choose one of the 30 ANSI-approved frames from the ProTec Eyewear kit or online catalog which are fully covered.