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2016 Benefits Guide
14
VISION INSURANCE
Our Vision benefit is provided by United
Healthcare. UHC offers you a wide variety
of doctor and retail location choices. 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.myuhc.com .United Healthcare 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
$130 Retail
$45
Contacts:
Reimbursement
Necessary
Paid in Full
$210
Selection
4 Boxes
$105
*covered within allowance
Lenticular
100%*
$80
Non-Selection
$105
$105
2016 Employee Vision
Contributions
Employee Deduction
Per Month
Employee
$5.76
Employee & Spouse
$10.61
Employee & Child(ren)
$11.11
Family
$16.65
Per Pay
Period
$2.88
$5.30
$5.55
$8.32