Page 7 - 2015 New Hire Guide
P. 7
Olshan Properties Corporate
Vision
Eligible employees have access to a comprehensive vision plan through Coverage
UnitedHealthcare. The vision plan covers routine eye exams and also
pays for all or a portion of the cost of glasses or contact lenses if you Important Things to
need them. Remember
Medically necessary contact lenses
To ind an in-network vision provider, use the Provider Locator on are determined at the provider’s
myuhcvision.com. You can also call 1-800-638-3120 and speak to a discretion for one or more of the
representative. following conditions: Following
post cataract surgery without
intraocular lens implant; to correct
Vision Benefit Summary extreme vision problems that
Out-of-
In-Network Network cannot be corrected with spectacle
lenses; with certain conditions
Exam $15 Copay Up to $40 of anisometropia; with certain
Lenses conditions of keratoconus .
Single $30 Copay Up to $40 An ID card is not required for
Bifocal $30 Copay Up to $60 service, but is available as a
Trifocal $30 Copay Up to $80 convenience to you should you
wish to have an ID card to take to
Lenticular $30 Copay Up to $80 your appointment . You can log on
Frames to www .myuhcvision .com to print
$130 retail frame allowance Up to $45 off your personalized ID card . All
Contacts the provider needs to verify your
Elective: The itting/evaluation fees, contact Elective: Up eligibility is your last name and
lenses, and up to two follow-up visits are to $105 date of birth .
covered in full (after $30 copay) . If you Medically If you go to an out-of-network
choose disposable contacts, up to 4 boxes are Necessary:
included . Up to $210 provider for service, receipts for
Medically Necessary: Covered in full after $30 services and materials purchased
copay on different dates must be
Frequency—Based on last date of service submitted together at the same
Exam, Lenses, 12 months time to receive reimbursement .
or Contacts (in Receipts must be submitted
lieu of glasses) within 12 months of date of
Frames 24 months service to the following address:
Bi-Weekly Employee Contributions UnitedHealthcare Vision Attn .
Employee (Ee) $2 .53 Claims Department P .O . Box 30978
Ee/Spouse $4 .68 Salt Lake City, UT 84130 FAX:
Ee/Child(ren) $4 .90 248 .733 .6060 .
Family $7 .33
7
Vision
Eligible employees have access to a comprehensive vision plan through Coverage
UnitedHealthcare. The vision plan covers routine eye exams and also
pays for all or a portion of the cost of glasses or contact lenses if you Important Things to
need them. Remember
Medically necessary contact lenses
To ind an in-network vision provider, use the Provider Locator on are determined at the provider’s
myuhcvision.com. You can also call 1-800-638-3120 and speak to a discretion for one or more of the
representative. following conditions: Following
post cataract surgery without
intraocular lens implant; to correct
Vision Benefit Summary extreme vision problems that
Out-of-
In-Network Network cannot be corrected with spectacle
lenses; with certain conditions
Exam $15 Copay Up to $40 of anisometropia; with certain
Lenses conditions of keratoconus .
Single $30 Copay Up to $40 An ID card is not required for
Bifocal $30 Copay Up to $60 service, but is available as a
Trifocal $30 Copay Up to $80 convenience to you should you
wish to have an ID card to take to
Lenticular $30 Copay Up to $80 your appointment . You can log on
Frames to www .myuhcvision .com to print
$130 retail frame allowance Up to $45 off your personalized ID card . All
Contacts the provider needs to verify your
Elective: The itting/evaluation fees, contact Elective: Up eligibility is your last name and
lenses, and up to two follow-up visits are to $105 date of birth .
covered in full (after $30 copay) . If you Medically If you go to an out-of-network
choose disposable contacts, up to 4 boxes are Necessary:
included . Up to $210 provider for service, receipts for
Medically Necessary: Covered in full after $30 services and materials purchased
copay on different dates must be
Frequency—Based on last date of service submitted together at the same
Exam, Lenses, 12 months time to receive reimbursement .
or Contacts (in Receipts must be submitted
lieu of glasses) within 12 months of date of
Frames 24 months service to the following address:
Bi-Weekly Employee Contributions UnitedHealthcare Vision Attn .
Employee (Ee) $2 .53 Claims Department P .O . Box 30978
Ee/Spouse $4 .68 Salt Lake City, UT 84130 FAX:
Ee/Child(ren) $4 .90 248 .733 .6060 .
Family $7 .33
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