Page 14 - Dragados 2022 Benefits Guide

UNITEDHEALTHCARE VISION PLAN*
In-Network
Out-of-Network
UHC Plan Provisions
Plan Copays
Eye Exam
Once every calendar year
Lenses
Once every calendar year
Single Vision Lenses
Lined Bifocal Lenses
Lined Trifocal Lenses
Lenticular Lenses
Frames
Once every calendar year
Elective Contact Lenses Once every calendar year
14
Dragados 2022 Benefits Guide
Vision Plan
Administered by UnitedHealthcare
Regular eye examinations can not only determine your need for corrective eyewear, but also may detect general health problems in their earliest stages. Protection for the eyes should be a major concern to everyone, and regular
eye exams are recommended. All benefits eligible employees may elect to enroll in the vision plan offered by UnitedHealthcare.
For any questions about the vision plan and resources available to you, call UnitedHealthcare toll free at 1-800-638-3120 or visit myuhc.com
Your United Healthcare vision plan includes a national network of eye doctors, optometrists and opthamologists in both private practice and retail settings. Additional online retailers are now in-network, including Warby Parker and glassesusa.com. You don’t need an ID card, either, just contact your provider and let them know you have United Vision coverage.
Eye Exam: $10 copay Materials: $25 copay
Covered in full after Exam copay
After Materials copay:
Covered in full Covered in full Covered in full Covered in full
Covered in full up to $150 allowance; 30% discount on amount exceeding the $150 allowance
Covered up to $120 (instead of lenses and frames)
Eye Exam: $10 copay Materials: $25 copay
Reimbursed up to $45 after Exam copay
After Materials copay, reimbursed up to:
$40
$60
$80
$80
$45
$150 (includes contact lens exam and materials)
*Please refer to your benefit summary for further details on plan coverage provisions.