Page 11 - 61st Street Service Corporation | 2022 Benefits

Vision Plan
Administered by UnitedHealthcare
UnitedHealthcare Vision
(800) 638–3120 www.myuhcvision.com
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. Your vision coverage is through UnitedHealthcare.
Summary of 2022 Vision Plan Benefits & Costs
UnitedHealthcare Vision Care
In-Network
Out-of-Network
Routine Eye Exam (every 12 months)
Lenses (every 12 months)
Frames (every 24 months)
Contacts (every 12 months) (In lieu of standard frames and lenses)
100% after $10 copay
100% after $25 copay
$25 copay for Spectera Selection. Up to $130 for Frames.
$25 copay for Spectera Selection (and if medically necessary). Up to $105 for Non-Selection.
$40 allowance
$40 allowance for single $60 allowance for bifocal $80 allowance for trifocal/ linticular
$45 allowance per person
$105 allowance per person; up to $210 if medically necessary for Spectera Selection $210 allowance
if medically necessary for Non-Selection
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