Page 8 - 2016 WFF Guide 1
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V ision
A comprehensive vision plan is offered through UnitedHealthcare (UHC)
Vision. With UHC Vision you get more than a standard vision beneit.
As a UHC Vision member you can use your beneits at private practice
and retail-afiliated providers across the country, most with evening or
weekend appointments available. Claim forms will not be required when
utilizing UHC Vision providers. For information on providers nearest
you, visit www.myuhcvision.com or call 800.638.3120.
I n- N etw ork O ut- of- N etw ork
E x am $ 1 0 copay U p to $ 4 0 reimbursement
S ingle lenses $ 2 5 copay U p to $ 4 0 reimbursement
B ifocal lenses $ 2 5 copay U p to $ 6 0 reimbursement
Trifocal lenses $ 2 5 copay U p to $ 8 0 reimbursement
L enticular lenses $ 2 5 copay U p to $ 8 0 reimbursement
F rames U p to $ 1 3 0 retail U p to $ 4 5 reimbursement
allow ance plus 3 0 %
d iscount on av erage
C ontacts E lectiv e: $ 2 5 copay E lectiv e: up to $ 1 0 5
M ed ically necessary: reimbursement
cov ered - in- full M ed ically necessary: up to
$ 2 1 0 reimbursement
L aser surgery 1 5 % d iscount off N ot applicable
retail or 5 % off
promotional price
F req uency
E x am 1 2 months
L enses 1 2 months
C ontacts ( in lieu of glasses) 1 2 months
F rames 2 4 months
This summary of beneits is intended to be a brief outline of coverage. The entire provisions of
beneits and exclusions are contained in the Summary Plan Description (SPD). In the event of a
conlict between the SPD and this description, the terms of the SPD will prevail.
V ision
A comprehensive vision plan is offered through UnitedHealthcare (UHC)
Vision. With UHC Vision you get more than a standard vision beneit.
As a UHC Vision member you can use your beneits at private practice
and retail-afiliated providers across the country, most with evening or
weekend appointments available. Claim forms will not be required when
utilizing UHC Vision providers. For information on providers nearest
you, visit www.myuhcvision.com or call 800.638.3120.
I n- N etw ork O ut- of- N etw ork
E x am $ 1 0 copay U p to $ 4 0 reimbursement
S ingle lenses $ 2 5 copay U p to $ 4 0 reimbursement
B ifocal lenses $ 2 5 copay U p to $ 6 0 reimbursement
Trifocal lenses $ 2 5 copay U p to $ 8 0 reimbursement
L enticular lenses $ 2 5 copay U p to $ 8 0 reimbursement
F rames U p to $ 1 3 0 retail U p to $ 4 5 reimbursement
allow ance plus 3 0 %
d iscount on av erage
C ontacts E lectiv e: $ 2 5 copay E lectiv e: up to $ 1 0 5
M ed ically necessary: reimbursement
cov ered - in- full M ed ically necessary: up to
$ 2 1 0 reimbursement
L aser surgery 1 5 % d iscount off N ot applicable
retail or 5 % off
promotional price
F req uency
E x am 1 2 months
L enses 1 2 months
C ontacts ( in lieu of glasses) 1 2 months
F rames 2 4 months
This summary of beneits is intended to be a brief outline of coverage. The entire provisions of
beneits and exclusions are contained in the Summary Plan Description (SPD). In the event of a
conlict between the SPD and this description, the terms of the SPD will prevail.
