Page 10 - WJ Bradley 2015 Annual Enrollment
P. 10
Beneits Guide
Vision Vision
The United Healthcare Vision Plan (Spectera) provides beneits to
you when you or a covered family member incurs eligible vision
expenses on routine eye exams and eye-care products. Greater
beneits are provided when you visit an in-network provider. Visit
www.myuhcvision.com to search for in-network providers using the
“Provider Quick Search” option in the bottom left corner of the
screen. When you do, the entire cost of the service or item is covered
after you pay the copayment shown in the chart below.
Plan Summary
UHC Spectera
Network Non-Network
Copay
Exam $10 copay
Materials $10 copay
Eye Examination
Exam 100% Up to $40
Lenses
Single Vision 100% Up to $40
Bifocal 100% Up to $60
Trifocal 100% Up to $80
Lenticular 100% Up to $80
Frames
Retail Up to $130 Up to $45
Contacts
Medically necessary 100% Up to $210
All other contacts Up to $150 Up to $150
Frequency
Exams 12 months
Lenses 12 months
Contacts (in lieu of glasses) 12 months
Frames 12 months
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Vision Vision
The United Healthcare Vision Plan (Spectera) provides beneits to
you when you or a covered family member incurs eligible vision
expenses on routine eye exams and eye-care products. Greater
beneits are provided when you visit an in-network provider. Visit
www.myuhcvision.com to search for in-network providers using the
“Provider Quick Search” option in the bottom left corner of the
screen. When you do, the entire cost of the service or item is covered
after you pay the copayment shown in the chart below.
Plan Summary
UHC Spectera
Network Non-Network
Copay
Exam $10 copay
Materials $10 copay
Eye Examination
Exam 100% Up to $40
Lenses
Single Vision 100% Up to $40
Bifocal 100% Up to $60
Trifocal 100% Up to $80
Lenticular 100% Up to $80
Frames
Retail Up to $130 Up to $45
Contacts
Medically necessary 100% Up to $210
All other contacts Up to $150 Up to $150
Frequency
Exams 12 months
Lenses 12 months
Contacts (in lieu of glasses) 12 months
Frames 12 months
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