Page 8 - 2016 WFF Guide 3
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Vision
A comprehensive vision plan is offered through UnitedHealthcare (UHC)
Vision. With UHC Vision you get more than a standard vision beneit.
As a UHC Vision member you can use your beneits at private practice
and retail-afiliated providers across the country, most with evening or
weekend appointments available. Claim forms will not be required when
utilizing UHC Vision providers. For information on providers nearest
you, visit www.myuhcvision.com or call 800.638.3120.
In-Network Out-of-Network
Exam $10 copay Up to $40 reimbursement
Single lenses $25 copay Up to $40 reimbursement
Bifocal lenses $25 copay Up to $60 reimbursement
Trifocal lenses $25 copay Up to $80 reimbursement
Lenticular lenses $25 copay Up to $80 reimbursement
Frames Up to $130 retail Up to $45 reimbursement
allowance plus 30%
discount on average
Contacts Elective: $25 copay Elective: up to $105
Medically necessary: reimbursement
covered-in-full Medically necessary: up to
$210 reimbursement
Laser surgery 15% discount off Not applicable
retail or 5% off
promotional price
Frequency
Exam 12 months
Lenses 12 months
Contacts (in lieu of glasses) 12 months
Frames 24 months
This summary of beneits is intended to be a brief outline of coverage. The entire provisions of
beneits and exclusions are contained in the Summary Plan Description (SPD). In the event of a
conlict between the SPD and this description, the terms of the SPD will prevail.
Vision
A comprehensive vision plan is offered through UnitedHealthcare (UHC)
Vision. With UHC Vision you get more than a standard vision beneit.
As a UHC Vision member you can use your beneits at private practice
and retail-afiliated providers across the country, most with evening or
weekend appointments available. Claim forms will not be required when
utilizing UHC Vision providers. For information on providers nearest
you, visit www.myuhcvision.com or call 800.638.3120.
In-Network Out-of-Network
Exam $10 copay Up to $40 reimbursement
Single lenses $25 copay Up to $40 reimbursement
Bifocal lenses $25 copay Up to $60 reimbursement
Trifocal lenses $25 copay Up to $80 reimbursement
Lenticular lenses $25 copay Up to $80 reimbursement
Frames Up to $130 retail Up to $45 reimbursement
allowance plus 30%
discount on average
Contacts Elective: $25 copay Elective: up to $105
Medically necessary: reimbursement
covered-in-full Medically necessary: up to
$210 reimbursement
Laser surgery 15% discount off Not applicable
retail or 5% off
promotional price
Frequency
Exam 12 months
Lenses 12 months
Contacts (in lieu of glasses) 12 months
Frames 24 months
This summary of beneits is intended to be a brief outline of coverage. The entire provisions of
beneits and exclusions are contained in the Summary Plan Description (SPD). In the event of a
conlict between the SPD and this description, the terms of the SPD will prevail.
