Page 7 - 2015 New Hire Guide
P. 7
Olshan Properties
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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