Page 22 - Vistra Demo

ADDITIONAL BENEFITS Visit www.myuhcvision.com for Vision Benefits

covered lens options, member
ID cards, participating vision
The Vision Plan is offered through United Healthcare (UHC) Vision and
providers and 12 months of
allows you to see any provider you choose. You can find network providers
claims history.
by accessing UHC’s site at www.myuhcvision.com or by contacting our
Compass MyHealth Pros at 1-877-546-4146.
Participants in the vision plan are also eligible to receive discounts on laser
vision correction surgery and digital hearing aids. More information about
these discounts are available in your Benefits Handbook under the MyHR
tab on Connect, click HR Services.

If you choose a If you choose an
Service UHC Vision provider… out-of-network provider…
You pay … You are reimbursed up to…
Professional fees
Vision exam (two per $10 $40
year)
Retinal screening $10 $0
photography
Materials
Single vision lenses $0 1 $40
Bifocal lenses $0 1 $60
Trifocal lenses $0 1 $80
Lenticular lenses $0 $80
Polycarbonate lenses for $0 $0
children to age 19
Frames (every 12 months) $0, up to $130 $45
benefit per year
Scratch resistant coating $0 $0
or Ultra-violet coating
Tinted lenses $0 $0
Contact lenses
Medically necessary 2 $0 $210
Elective 3 $0 for up to four boxes (12 $105
pairs) of disposables from
the provider’s covered-
in-full selection. If you
choose contacts not
included in the covered-
in-full selection, such as
bifocal contacts, you will
pay anything over $105.
1 Popular lens upgrades (such as no line bifocals and anti-reflective coating) are available at a
discount.
2 Contact lenses are considered medically necessary if your eyesight cannot be corrected
with eyeglasses or as determined by your provider. If you select contacts for any other
reason, they are considered elective.
3 If you choose contact lenses under this plan, you will not be eligible for frames until the next
calendar year.

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