Page 10 - PSA 2020-21 New Hire Guide

2020-21 Hew Hire Guide

Voluntary Vision

We partner with United Healthcare to offer you
and your family members vision insurance. Visit
www.myuhc.com to ind in-network providers and
access to a variety of online tools and programs.

In-Network Out-of-Network
Copay
Exam $10 copay N/A
Materials $20 copay N/A
Lenses
Single Covered in full $40 allowance
Bifocal Covered in full $60 allowance
Trifocal Covered in full $80 allowance
Lenticular Covered in full $80 allowance
Frames
$130 allowance;
30% discount on
frame coverage $45 allowance
at participating
providers
Contacts
Elective $125 allowance $125 allowance
Therapeutic Covered in full $210 allowance
Frequency
Exam 12 months
Lenses 12 months
Contacts (in lieu of 12 months
glasses)
Frames 24 months

This is a high level summary of your beneit coverage. Full coverage
details are available in your summary plan description (SPD). In the event
there is a discrepancy between what is relected in this guide and what is
communicated in your SPD, the terms of your SPD will prevail.

Semi-Monthly Pre-Tax Employee
Remember to visit in-network optometrist to receive the
deepest level of discount on your services. Vision Contributions

To ind a participating in-network dentist in your area, go to Employee Only $2.52
www.myuhc.com. Employee and Spouse $5.04
Employee and Child(ren) $5.09
Family $8.13

* Employees classiied as SCA, see page 19 for employer deductions to
health and welfare.
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