Page 8 - My FlipBook
P. 8
2016 Beneits Newsletter
Vision Coverage
Important Things to
Remember Eligible employees have access to a comprehensive vision plan
An ID card is not required for through UnitedHealthcare. The vision plan covers routine eye exams
service, but is available as a and also pays for all or a portion of the cost of glasses or contact
convenience to you should you lenses if you need them.
wish to have an ID card to take to
your appointment; you can log on To ind an in-network vision provider, use the Provider Locator on
to www.myuhcvision.com to print
off your personalized ID card; all myuhcvision.com. You can also call 800.638.3120 and speak to a
the provider needs to verify your representative.
eligibility is your last name and date
of birth Vision Benefit Summary
If you go to an out-of-network Out-of-
provider for service, receipts for In-Network Network
services and materials purchased on Exam $15 copay Up to $40
different dates must be submitted Lenses
together at the same time to receive Single $30 copay Up to $40
reimbursement; receipts must be Bifocal $30 copay Up to $60
submitted within 12 months of date
of service to the following address: Trifocal $30 copay Up to $80
UnitedHealthcare Vision Attn. Claims Lenticular $30 copay Up to $80
Department P.O. Box 30978 Salt Lake Frames
City, UT 84130 FAX: 248.733.6060 $130 retail frame allowance; Up to $45
Medically necessary contact lenses 30% off overage amount at participating
are determined at the provider’s providers
discretion for one or more of the Elective Contact Lenses
following conditions: following post Covered $30 copay, includes up to 4 boxes Up to $105
cataract surgery without intraocular selection
lens implant; to correct extreme
vision problems which cannot be Necessary $30 copay, then covered at 100% Up to $210
corrected with spectacle lenses; with contact lenses
certain conditions of anisometropia; Frequency—Based on last date of service
with certain conditions of Exam, lenses, 12 months
keratoconus or contacts (in
lieu of glasses)
Frames 24 months
Bi-Weekly Employee Contributions
Employee (Ee) $2.53
Ee/Spouse $4.68
Ee/Child(ren) $4.90
Family $7.33
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Vision Coverage
Important Things to
Remember Eligible employees have access to a comprehensive vision plan
An ID card is not required for through UnitedHealthcare. The vision plan covers routine eye exams
service, but is available as a and also pays for all or a portion of the cost of glasses or contact
convenience to you should you lenses if you need them.
wish to have an ID card to take to
your appointment; you can log on To ind an in-network vision provider, use the Provider Locator on
to www.myuhcvision.com to print
off your personalized ID card; all myuhcvision.com. You can also call 800.638.3120 and speak to a
the provider needs to verify your representative.
eligibility is your last name and date
of birth Vision Benefit Summary
If you go to an out-of-network Out-of-
provider for service, receipts for In-Network Network
services and materials purchased on Exam $15 copay Up to $40
different dates must be submitted Lenses
together at the same time to receive Single $30 copay Up to $40
reimbursement; receipts must be Bifocal $30 copay Up to $60
submitted within 12 months of date
of service to the following address: Trifocal $30 copay Up to $80
UnitedHealthcare Vision Attn. Claims Lenticular $30 copay Up to $80
Department P.O. Box 30978 Salt Lake Frames
City, UT 84130 FAX: 248.733.6060 $130 retail frame allowance; Up to $45
Medically necessary contact lenses 30% off overage amount at participating
are determined at the provider’s providers
discretion for one or more of the Elective Contact Lenses
following conditions: following post Covered $30 copay, includes up to 4 boxes Up to $105
cataract surgery without intraocular selection
lens implant; to correct extreme
vision problems which cannot be Necessary $30 copay, then covered at 100% Up to $210
corrected with spectacle lenses; with contact lenses
certain conditions of anisometropia; Frequency—Based on last date of service
with certain conditions of Exam, lenses, 12 months
keratoconus or contacts (in
lieu of glasses)
Frames 24 months
Bi-Weekly Employee Contributions
Employee (Ee) $2.53
Ee/Spouse $4.68
Ee/Child(ren) $4.90
Family $7.33
8
