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Donald Danforth Plan Science Center
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VISION INSURANCE
UnitedHealthcare (UHC) Vision
Benefit/Service
In Network
Out of Network
Benefit
Examination
$10 Co-pay
$40 reimbursement
Frequency of Service:
Exam
Every 12 months
Lenses
Every 12 months
Frames
Every 24 months
Lenses:
$25 Co-pay then:
Reimbursement:
Single
100%*
$40
Bifocal
100%*
$60
Trifocal
100%*
$80
Frames
*Covered 100% up to
$50 Wholesale/$130
Retail
$45
Contacts:
Reimbursement
Necessary
Covered at 100%
$210
Cosmetic
$105 Allowance
$105
*
With UnitedHealthcare Vision’s frame benefit, all frames with a $50 wholesale cost or
less are covered in-full at private practice providers. For any frame over $50 at private
practice providers, the member pays the difference between the wholesale cost of the
frame and the $50 allowance. Plan participants receive $130 retail frame allowance for
frames purchased at a retail chain and for any frame above the $130 retail, the member
will pay the difference.
2016 Employee Vision Contributions
Vision Employee Cost
Employee
Monthly Cost
Employee Per
Pay Period
Cost
Employee
$5.40
$2.70
Employee & Spouse
$9.94
$4.97
Employee & Child(ren)
$10.42
$5.21
Family
$15.60
$7.80
Our Vision benefit is provided by
UnitedHealthcare. If you utilize an out
of network provider, your benefit is
based on a reimbursement schedule.
Also, if you are considering Lasik
surgery, there is a discount available.
You can review a full list of providers
at
www.myuhcvision.com .