JUNE 2017 CI OPTICAL SELECTION GUIDE HEALTH CARE AUTHORITY VISION PROVIDERS

JUNE 2017 CI OPTICAL SELECTION GUIDE HEALTH CARE AUTHORITY VISION PROVIDERS

CI OPTICAL Since 1997, the Washington State Correctional Industries Optical Program has been training their offenders to produce high quality, cost effective prescription eyewear. Our high capacity optical production facility is designed to supply large volume contracts as well as small entities. Our state of the art production facility is complemented by a highly experienced civilian supervisory staff ready to serve your vision hardware needs. In addition to our prescription eyewear services, we also offer a line of premade reading glasses designed specifically for the correctional/ institutional environment. EYE WEAR REQUESTS Agency policy may affect eligibility. Please contact the CI Optical Lab if you have any questions. Providers, please include legible Rx with complete information, i.e., frame name, color, eye size, DBL (skull or cable temples), and any applicable codes. Do not Fax POF orders; jobs start when patient s frame arrives, and please include Rx with frame. CI Optical does not sell or credit frames for patients to try out. CI OPTICAL CUSTOMER CARE TABLE OF CONTENTS 3 MEN'S FRAMES Metal Plastic 6 WOMEN'S FRAMES Metal Plastic 10 YOUNG ADULT FRAMES Metal Plastic 15 CHILDREN'S FRAMES Metal Plastic 20 SPECIALITY FRAMES Metal Plastic 22 SAFETY FRAMES 24 GENERAL INFORMATION Pricing (SB5352 clients only) Warranty Hours of Operation: 7:00 am to 4:00 pm Monday - Friday Closed for Washington state observed Holidays CIOpticalCustomerCare@doc.wa.gov TOLL FREE 888.606.7788 FAX 888.606.7789 1. 8 8 8. 6 0 6. 7 7 8 8 2 www.washingtonci.com

MEN'S FRAMES EQ 230 58/16/145 NEW! Color not shown: EQ231 60/17/145 NEW! Color not shown: GUNMETAL Icon 51/19/135 53/19/140 Pride 54/17/140 ANTIQUE SILVER GUNMETAL 1. 8 8 8. 6 0 6. 7 7 8 8 3 www.washingtonci.com

MEN'S FRAMES ZB008A 53/19/145 55/19/150 Nate 48/18/135 50/18/135 52/18/140 54/20/145 56/20/145 58/20/150 Color not shown: FADE GREY FADE GOLD SHADOW ANTIQUE SILVER Matthew 54/17/140 GREY OLIVE TORTOISE 1. 8 8 8. 6 0 6. 7 7 8 8 4 www.washingtonci.com

MEN'S FRAMES Soho 1014 53/17/140 CRYSTAL/ /RED /BLUE DEMI PURPLE SW229 55/16/140 NEW! TORTOISE 1. 8 8 8. 6 0 6. 7 7 8 8 5 www.washingtonci.com

WOMEN'S FRAMES Agnes 52/18/135 Stainless Steel EQ201 50/18/140 52/18/145 LILAC PEWTER ROSE EQ202 50/19/135 52/19/140 GOLD GUNMETAL 1. 8 8 8. 6 0 6. 7 7 8 8 6 www.washingtonci.com

WOMEN'S FRAMES Maria 53/17/135 Metaflex 1029 51/17/140 GOLD/PEARL BURGUNDY MOCHA/ VIOLET PLUM/PINK 1. 8 8 8. 6 0 6. 7 7 8 8 7 www.washingtonci.com

WOMEN'S FRAMES EQ303 53/16/140 Gracious 51/18/140 /BLUE /VIOLET CHERRY /ROSE 1. 8 8 8. 6 0 6. 7 7 8 8 8 www.washingtonci.com

WOMEN'S FRAMES Soho 108 52/16/140 Soho 1013 52/16/140 /CRYSTAL / /PURPLE /AQUA TORTOISE WINE/PURPLE Sunset 51/17/135 UL91 52/20/140 /ORANGE GREY/PURPLE PINK OLIVE/GREEN 1. 8 8 8. 6 0 6. 7 7 8 8 9 www.washingtonci.com

YOUNG ADULT FRAMES ASAP 49/20/140 Cheerful 42/18/125 44/18/130 /SILVER AMBER BLUE/SILVER GOLD /SILVER Finale 48/19/135 50/19/140 Lucid 54/18/140 ANTIQUE ANTIQUE SILVER GOLD ORCHID 1. 8 8 8. 6 0 6. 7 7 8 8 10 www.washingtonci.com

YOUNG ADULT FRAMES SW312 49/20/140 Todd 46/18/135 48/18/140 50/18/145 ANTIQUE ANTIQUE GOLD GUNMETAL MATTE 7724 51/19/135 Aurora 48/19/135 COFFEE BURGUNDY PURPLE BURGUNDY 1. 8 8 8. 6 0 6. 7 7 8 8 11 www.washingtonci.com

YOUNG ADULT FRAMES Belong 51/17/140 Corvette 49/19/140 /CRYSTAL PLUM/CRYSTAL BLUE TORTOISE LILAC Lindsay 50/16/135 Melissa 47/17/140 BURGUNDY VIOLET RED 1. 8 8 8. 6 0 6. 7 7 8 8 12 www.washingtonci.com

YOUNG ADULT FRAMES Soho 1011 50/19/140 SW208 50/18/140 53/18/145 /GREY GREY PURPLE TORTOISE SW 227 53/16/145 SW319 48/17/140 BURGUNDY /CRYSTAL PLUM NAVY TORTOISE 1. 8 8 8. 6 0 6. 7 7 8 8 13 www.washingtonci.com

YOUNG ADULT FRAMES SW 438 48/19/135 U-21 50/18/145 Urban 51/17/140 /BLUE Yale 46/19/135 CRYSTAL MATTE CRYSTAL/ NAVY/TORTOISE MATTE TORTOISE MATTE TORTOISE 1. 8 8 8. 6 0 6. 7 7 8 8 14 www.washingtonci.com

CHILDREN'S FRAMES Hide & Seek 42/19/125 44/19/130 Junior 35/18/115 37/18/120 39/18/125 41/18/125 AMBER NAVY BLUE PURPLE ROSE Pumpkin 40/16/120 40/16/C30 42/16/125 42/16/C35 Cable and Skull Temples Available ANTIQUE BLUE GOLD 1. 8 8 8. 6 0 6. 7 7 8 8 15 www.washingtonci.com

CHILDREN'S FRAMES Kendall 45/17/130 Shortstop 43/17/120 45/17/125 BLUE NAVY ANT 1. 8 8 8. 6 0 6. 7 7 8 8 16 www.washingtonci.com

CHILDREN'S FRAMES Bashful 42/16/130 Bronx 46/18/130 /CRYSTAL BLUE/ROSE /ROSE BURGUNDY/BLUE TORTOISE FADE MP81 38/15/140 Cable Temples Peewee 36/14/115 38/14/120 BLUE BLUE TORTOISE 1. 8 8 8. 6 0 6. 7 7 8 8 17 www.washingtonci.com

CHILDREN'S FRAMES Solo Bambini frames on this page require prior authorization. Itsy Bitsy 30/13 Flexible Safe Available colors: Teeny Weeny 35/14 Flexible Safe Available colors: 100 101 102 103 103.1 104 100 101 102 103 103.1 104 Ice Strawberry Ice Pink Turquoise Ice Ice Blue Blue Ice Strawberry Ice Pink Turquoise Ice Ice Blue Blue 105 106 107 108 109 110 105 106 107 108 109 110 Yellow Watermelon Red Green Lavender Denim Root Beer Yellow Watermelon Red Green Lavender Denim Root Beer 111 117 Charcoal Plum ICE BLUE BLUE STRAWBERRY ICE Toddler YELLOW 40/15 Flexible Safe Available colors: Rascal 43/16 100 Ice 101 Strawberry Ice 102 Pink 103 Turquoise Ice 103.1 Ice Blue 104 Blue Flexible Safe Available colors: 105 106 107 108 109 110 100 102 103.1 106 109 110 Yellow Watermelon Red Green Lavender Denim Root Beer Ice Pink Ice Blue Watermelon Red Denim Root Beer 111 Charcoal 117 Plum 111 Charcoal 115 Khaki 116 Orange 117 Plum GREEN KHAKI PINK ORANGE 1. 8 8 8. 6 0 6. 7 7 8 8 18 www.washingtonci.com

Solo Bambini frames on this page require prior authorization. CHILDREN'S FRAMES Rookie 38/14 42/15 44/16 Flexible Safe Available colors: Scout 45/18 Flexible Safe Available colors: 100 Ice 101 Strawberry Ice 102 Pink 103 Turquoise Ice 103.1 Ice Blue 104 Blue 100 Ice 106 Watermelon Red 109 Denim 110 Root Beer 111 Charcoal 112 Forest 105 Yellow 106 Watermelon Red 107 Green 108 Lavender 109 Denim 110 Root Beer 113 Red 114 Peony 111 117 Charcoal Plum DENIM TURQUOISE ICE (38/14) PEONY PLUM (42/15) ROOT BEER (44/16) Eagle Scout 50/20 Flexible Safe Available colors: 100 102 109 110 111 112 Scout Master Ice Pink Denim Root Beer Charcoal Forest 55/22 Flexible Safe 113 Red Available colors: 100 109 110 111 112 113 Ice Denim Root Beer Charcoal Forest Red FOREST RED ICE 1. 8 8 8. 6 0 6. 7 7 8 8 19 www.washingtonci.com

SPECIALTY FRAMES Specialty frames may require authorization. Jim 54/18/140 Flexible Frame Color not shown: GUNMETAL Josh 49/18/135 Flexible Frame Color not shown: ANTIQUE BLUE GOLD SATIN COFFEE Jayme 41/18/120 Flexible Frame Paige 46/20/135 Flexible Frame LIGHT MATTE NAVY GUNMETAL PLUM WINE 1. 8 8 8. 6 0 6. 7 7 8 8 20 www.washingtonci.com

Specialty frames may require authorization. SPECIALTY FRAMES Stan 54/18/140 Flexible Frame All American See Frame Sizing Below Durable, Athletic Frame Adjustable Strap Colors not shown: See below COFFEE Not Shown: BLUE W/WHITE BRIDGE, W/TAN BRIDGE, WHITE, GRAY W/ BRIDGE, RED W/ BRIDGE, RED W/WHITE BRIDGE Eye Size DBL Temple 44 20 or 23 Adjustable 47 20 or 23 Adjustable GOLD 50 20 or 23 Adjustable 53 23 Adjustable Apollo See Frame Sizing Below Durable Frame GUNMETAL Eye Size DBL Temple 42 18, 20, 22 130, 135, 140, 145, 150 44 18, 20, 22 130, 135, 140, 145, 150 46 20 or 22 130, 135, 140, 145, 150 48 20 or 22 130, 135, 140, 145, 150 50 20, 22, 24 130, 135, 140, 145, 150 52 20, 22, 24 130, 135, 140, 145, 150 1. 8 8 8. 6 0 6. 7 7 8 8 21 www.washingtonci.com

SAFETY FRAMES Specialty frames may require authorization. SC 900 52/14/140 54/14/145 56/15/150 Durable Z87 Rating Available with Side Shields SP 83 50/20/140 52/20/145 54/20/150 Durable Z87 Rating Available with Side Shields SMOKE GREY TAN 1. 8 8 8. 6 0 6. 7 7 8 8 22 www.washingtonci.com

GENERAL INFORMATION PRICING FOR QUALIFIED CLIENTS OF SENATE BILL 5352 Frame Pricing Standard frames $10.00 Safety frames $25.00 Specialty frames $60.00 Package Pricing Single Vision Base Package: Standard Frame $10.00 Left Single Vision $6.00 Right Single Vision $6.00 Total $22.00 Bifocal Base Package: Standard Frame $10.00 Left Bifocal $11.00 Right Bifocal $11.00 Total $32.00 Trifocal Base Package: Standard Frame $10.00 Left Trifocal $16.00 Right Trifocal $16.00 Total $42.00 Single Vision Specialty Package: Durable or Flexible Frame $60.00 Left Single Vision $6.00 Right Single Vision $6.00 Total $72.00 Bifocal Specialty Package: Durable or Flexible Frame $60.00 Left Bifocal $11.00 Right Bifocal $11.00 Total $82.00 Trifocal Specialty Package: Durable or Flexible Frame $60.00 Left Trifocal $16.00 Right Trifocal $16.00 Total $92.00 1. 8 8 8. 6 0 6. 7 7 8 8 23 PRICING FOR QUALIFIED CLIENTS OF SB 5352 (Continued) Options Pricing Slab off prism, plastic (per lens) $20.00 Lenticular (per pair) $30.00 Press-on Fresnel Prism (per lens) $20.00 Prism over 3 Diopters - Add per Diopter (per lens) $1.50 Mid Index (per pair) $40.00 High Index (per pair) $50.00 Polycarbonate lens (per pair) $30.00 Progressive lens- Added to trifocal price (per pair) $75.00 Photochromatic (brown or gray) (per pair) $50.00 Polarized (brown or gray) (per pair) $75.00 Antireflective coating (per pair) $40.00 Fashion Tints: Tint - solid (per pair) $5.00 Tint - gradient (per pair) $6.00 Tint - double gradient (per pair) $8.00 U-V lens coating (per pair) $6.00 Tint and U-V (2 or higher) (per pair) $11.00 Non-allergenic frame coating $10.00 Pattern fee for patient's own frame (per pair) $20.00 WARRANTY It is the policy of Washington State Correctional Industries (CI) to provide its customers with products and services that conform to their specifications and quality requirements. CI's goal is to achieve a constant high standard of quality while maintaining economical operations. All CI optical products are covered by a limited warranty as follows: Lenses are warranted for 90 days against manufacturer defect only. Lenses are NOT warranted against scratches. Due to time, exposure to elements and concealed damage working with patients own frame can be unpredictable. CI Optical does not accept responsibility for any outside frames sent in. CI Optical frames are warranted for one year against manufacturer defect only. Reworks due to doctor or dispenser errors, or patient satisfaction, are provided at no cost for the first rework within the first 90 days of original order and are billed at 100% thereafter. This only applies to prescriptions filled under Senate Bill 5352. All physician requested reworks filled for non-provider billed prescriptions are billed to the provider at 100% of the HCA contract price. All lab errors are reworked at no cost to the provider. CI covers all Solo Bambini frames for eligible clients when all the following clinical criteria are met: The client is age four or younger. The provider has documented the reasons that the standard CI Optical frames are not suitable for the client. To receive payment, providers must follow the agency's EPA process. See EPA #611. www.washingtonci.com

700-CA009 (R 6/2017) Department of Corrections PO Box 41115 Olympia, Washington 98504 CI OPTICAL CUSTOMER CARE CIOpticalCustomerCare@doc.wa.gov TOLL FREE 888.606.7788 FAX 888.606.7789