Page 8 - 2020 MAS Benefit Guide
P. 8
Vision Coverage
Because symptoms of health conditions often don’t appear until damage
has already occurred, eye exams are a great way to keep tabs on what’s
happening in your body. Our vision insurance coverage, offered in
partnership with UnitedHealthcare (UHC), is designed to meet a variety
of needs.
Find an In-Network Provider
Remember to visit in-network providers to receive the deepest level of
discount on your services. To ind a participating in-network provider in
your area, go to www.myuhc.com and select “Vision Provider.”
Vision Plan
In-Network Out-of-network
Copay
Exam $10 copay Up to $40 reimbursement
Materials $15 copay Varies, see plan document
Lenses
Single $15 copay Up to $40 reimbursement
Bifocal $15 copay Up to $60 reimbursement
Trifocal $15 copay Up to $80 reimbursement
Lenticular $15 copay Up to $80 reimbursement
Frames
$130 allowance; 30% of Up to $45 reimbursement
balance over $130
Contacts
Formulary Contacts Four boxes (covered after $130 allowance
materials copay)
Non-Formulary $130 allowance $130 allowance
Contacts
Frequency
Exam 12 months
Lenses 12 months
Contacts 12 months
2020 Employee Bi-Weekly (in lieu of glasses)
Contributions Frames
Employee Only $1.61 24 months
Employee + Spouse $3.23 This is a high level summary of your beneit coverage. Full coverage details are available in your
Employee + Child(ren) $3.07 summary plan description (SPD). In the event there is a discrepancy between what is relected in
Family $4.83 this guide and what is communicated in your SPD, the terms of your SPD will prevail.
8 2020 Benefits Guide
Because symptoms of health conditions often don’t appear until damage
has already occurred, eye exams are a great way to keep tabs on what’s
happening in your body. Our vision insurance coverage, offered in
partnership with UnitedHealthcare (UHC), is designed to meet a variety
of needs.
Find an In-Network Provider
Remember to visit in-network providers to receive the deepest level of
discount on your services. To ind a participating in-network provider in
your area, go to www.myuhc.com and select “Vision Provider.”
Vision Plan
In-Network Out-of-network
Copay
Exam $10 copay Up to $40 reimbursement
Materials $15 copay Varies, see plan document
Lenses
Single $15 copay Up to $40 reimbursement
Bifocal $15 copay Up to $60 reimbursement
Trifocal $15 copay Up to $80 reimbursement
Lenticular $15 copay Up to $80 reimbursement
Frames
$130 allowance; 30% of Up to $45 reimbursement
balance over $130
Contacts
Formulary Contacts Four boxes (covered after $130 allowance
materials copay)
Non-Formulary $130 allowance $130 allowance
Contacts
Frequency
Exam 12 months
Lenses 12 months
Contacts 12 months
2020 Employee Bi-Weekly (in lieu of glasses)
Contributions Frames
Employee Only $1.61 24 months
Employee + Spouse $3.23 This is a high level summary of your beneit coverage. Full coverage details are available in your
Employee + Child(ren) $3.07 summary plan description (SPD). In the event there is a discrepancy between what is relected in
Family $4.83 this guide and what is communicated in your SPD, the terms of your SPD will prevail.
8 2020 Benefits Guide
