Page 13 - Watermark Retirement Communities 2022 Benefits Guide Logan Square Union Before

Vision Plan

The vision plan provides coverage for routine eye exams and pays for all or a portion of the cost of glasses
or contact lenses. You can choose any provider; however, you always save money if you see in-network
providers. Your vision plan is provided through UnitedHealthcare.

Plan Provision In-Network Out-of-Network

Exam $10 copay Reimbursed up to $40

Frames Up to $100 allowance: 30% discount after allowance Up to $45
Lenses
 Single vision lenses $10 copay Reimbursed up to $40
 Bifocal lenses $10 copay Reimbursed up to $60
 Trifocal lenses $10 copay Reimbursed up to $80

Contact Lenses
 Elective $130 allowance for materials, fit and follow-up exam Reimbursed up to $130
 Medically necessary Covered in full Reimbursed up to $210

Frequency
 Exam 12 Months 12 Months
 Lenses 12 Months 12 Months
 Frames 24 Months 24 Months

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