Page 16 - GBS OE Brochure - Generic Hospitality

VISION BENEFITS
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 priority for everyone.
United Healthcare’s vision insurance offering is powered by the Spectera Eyecare Networks. United Healthcare owns and operates the Spectera Eyecare Network, which is the second largest eye care network in the country. Spectera Eyecare Network provides our members a choice between private practice and retail providers for routine eye care and materials. Any provider in the Spectera Eyecare Network accepts UnitedHealthcare vision.
UnitedHealthcare
In Network Bene ts:
Exams
$10 Copay
Materials
$25 Copay
Frames
$130 Retail Allowance (30% off Balance over $130)
Lenses
100% Coverage for Standard Single-Vision, Lined Bifocal, Lined Trifocal or Lenticular Lenses
Contact Lenses
$130 Allowance (100% Coverage for Medically Necessary)
In Network Contact Lenses:
Conventional Lenses
$130 Retail Allowance
Disposable Lenses
Medically Necessary Lenses
Covered in Full after applicable copay.
16 ABC COMPANY | HOSPITALITY
2017 OPEN ENROLLMENT
Out-of-Network Reimbursement:
Exams:
Reimbursed to $50
Frames:
Reimbursed to $70
Spectacle Lenses
(Single, Lined Bifocal, Lined Trifocal, Lenticular)
Reimbursed to $50 / $75 / $100 / $80
Contact Lens Evaluation, Fitting & Follow Up Care
The allowance for non-selection contact lenses applies to materials. No portion will be exclusively applied to the tting and evaluation.
Out-of-Network Contact Lenses:
Conventional Lenses
Reimbursed to $130
Disposable Lenses
Medically Necessary Lenses
$210 Retail Allowance
Frequency
Exams
Every 12 Months
Lenses
Contact Lenses
Every 12 Months (in place of Spectacle Lenses)
Frames
Every 12 Months