Benefit Guide - Stripes

VISION BENEFITS

UHC VISION PLAN

HOW TO FIND A VISION PROVIDER

BENEFIT

IN-NETWORK

OUT-OF-NETWORK

Eye Exam

$10 copay

Up to $40

1. Go to

Hardware (Frames and Lenses)

$25 copay

See below

www.uhcvision.com (if you are already a member go to www.myuhcvision.com ). 2. Under “Provider Quick menu and select “UnitedHealthcare Vision” . 3. Enter your search criteria (e.g., Zip or Address”). 4. Click “Search” . Search” click on the “ Network” drop-down

Frequency Exam Lenses Frames Contacts

Every 12 months Every 12 months Every 12 months Every 12 months

Frames

$130 allowance

Up to $45

Lenses Single Vision Lenses Bifocal & Progressive Vision Lenses Trifocal Vision Lenses Lenticular Vision Lenses Contact Lenses Fitting & Evaluation Elective Contact Lenses Medically Necessary Contact Lenses

Covered in full after copay Covered in full after copay Covered in full after copay Covered in full after copay

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

$30 allowance $105 allowance Covered in full after copay

Not covered Up to $80 Up to $210

Bi-Weekly Contributions Employee Only Employee + Spouse Employee + Child(ren) Employee + Family

$2.44 $4.63 $5.41 $7.62

DISCOUNTS - IN-NETWORK ONLY

Laser Vision

UnitedHealthcare (UHC) has partnered with QualSight LASIK, the largest LASIK manager in the U.S., to provide members with access to discounted laser vision correction providers. Member savings represent up to 35% off the national average price of Traditional LASIK. Contracted prices start at $945 per eye for Traditional LASIK and $1,395 per eye for Custom LASIK. Discounts are also provided on newer technologies such as Custom Bladeless (all laser) LASIK.

Additional Material You will receive up to 20% discount on an additional pair of eyeglasses or contact lenses. This program is available after your vision benefits have been exhausted. Please note that this discount shall not be considered insurance, and that UHC shall neither pay nor reimburse the provider or member for any funds owed or spent. Additional materials do not have to be purchased at the time of initial material purchase

Hearing Aids

Save on custom-programmed hearing aids when you buy them from UnitedHealthcare Hearing. To find out more go to www.UHCHearing.com. When placing your order use promo code MYVISION to get the special discount price.

10

QUESTIONS? Call Answers@benefitsvip.com at 866.286.5354