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2017 Benefits Guide
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See Clearly with Vision Insurance......
Benefit/Service
In Network
Out of Network
Examination Co-pay
$10 Co-pay
$40 reimbursement
Frequency of Service:
Exam
Lenses
Frames
Every 12 months
Every 12 months
Every 24 months
Lenses
Single
Bifocal
Trifocal
$25 Co-pay then:
100%
100%
100%
Reimbursement
$40
$60
$80
Frames
$25 Co-Pay then:
*Covered 100% up to
$130 retail
$45
Contacts
Necessary
Cosmetic
$25 Co-Pay then:
100%
Up to $105
Reimbursement
$210
$105
United Healthcare will remain our vision carrier. The United Healthcare vision network is national and includes
over 35,000 private practice and retail chain providers. To find a participating provider go to
www.myuhcvision.com.In addition to the benefits outlined in the table below, discounts for non-covered options, mail order contacts and
laser vision correction procedures are also available.
Coverage both in network and out of network is included in this plan. It is to your advantage to utilize a network
provider to take advantage of contracted fees. If you go out of network, you will be responsible for paying the
provider directly and seeking reimbursement from UHC for the amounts listed in the out of network column below.
With United Healthcare Vision’s
frame benefit, you will receive a
retail frame allowance toward
the purchase of any frame at a
network provider. For frames
that exceed your allowance, you
may receive an additional 30%
discount on the coverage
(available only at participating
providers and may exclude
certain frame manufacturers).