2024-Framebridge-Benefit Guide

VISION BENEFITS

Framebridge offers voluntary vision coverage through United HealthCare. Choose from thousands of independent and retail providers for the one that’s right for you. For a complete list of In -Network providers near you, visit www.myuhcvision.com.

VISION PLAN

SERVICE OR MATERIAL

IN-NETWORK

OUT-OF-NETWORK

FREQUENCY

Eye Exam

100% after $10 copay

Up to $40 allowance

Every 12 months

Lenses Single Vision Lined Bifocal Lined Trifocal Lenticular

100% after $10 copay 100% after $10 copay 100% after $10 copay 100% after $10 copay

Up to $40 allowance Up to $60 allowance Up to $80 allowance Up to $80 allowance

Every 12 months

Contact Lenses (In lieu of glasses) Covered Selection Contacts Medically Necessary Non-Selection Contacts

Up to 4 boxes 100% after $10 copay Up to $130 allowance

Up to $130 allowance Up to $210 allowance Up to $130 allowance

Every 12 months

Frames Private Practice Provider

100% after $25 copay up to $130 allowance 100% after $25 copay up to $130 allowance

Up to $45 reimbursement

Every 24 months

Retail Chain Provider

Up to $45 reimbursement

Vision Contributions Per Pay Period Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

$0.58 $2.76 $2.91 $4.28

For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

12