Page 9 - 61st Street Service Corp. | 2020 EPIC Benefits Guide

Vision Plan
Regular eye examinations can not only determine your need for corrective eyewear but also may detect general health problems in their earliest stages. Protection for the eyes should be a priority for everyone. Your vision coverage is through UnitedHealthcare.
UnitedHealthcare Vision
(800) 638 – 3120 www.myuhcvision.com
Summary of 2020 Vision Plan Benefits & Costs
Routine Eye Exam (every 12 months)
Lenses (every 12 months)
Frames (every 24 months)
Contacts (every 12 months)
(In lieu of standard frames and lenses)
UnitedHealthcare Vision Care
In-Network
100% after $10 copay
100% after $25 copay
$25 copay for Spectera Selection. Up to $130 for Frames.
$25 copay for Spectera Selection (and if medically necessary). Up to $105 for Non-Selection.
Out-of-Network
$40 allowance
$40 allowance for single
$60 allowance for bifocal
$80 allowance for trifocal/linticular
$45 allowance per person
$105 allowance per person; up to $210 if medically necessary for Spectera Selection
$210 allowance if medically necessary for Non-Selection
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