United Healthcare
Benefits at a Glance
| Plan Highlights | |
|---|---|
| Exam | $10 Copay/12 months |
| Lenses | $20 Copay/12 months |
| Frames | $20 Copay/24 months |
A list of services for UnitedHealthcare are detailed below:
| Benefit | In-Network | Out of Network Reimbursement |
|---|---|---|
| Exam | 100% | up to $40 |
| Lenses | ||
| Single Vision | 100% | up to $40 |
| Lined Bifocals | 100% | up to $60 |
| Lined Trifocals | 100% | up to $80 |
| Frames | 100% up to $130 Retail | up to $45 |
| Contact Lenses | ||
| Covered Elective | 100% up to 4 boxes | up to $105 |
| Other Elective | up to $105 | up to $105 |
| Necessary | 100% | up to $210 |
For more information, please review the Benefits Summary
Plan Documentation
Monthly Premiums
| Employee Only | $6.28 |
| Employee + One | $11.01 |
| Employee + Family | $18.14 |
Providers & Locator
To locate providers, call 1-800-839-3242 or use the UnitedHealthcare Vision Provider Locator at www.myuhcvision.com and click on Provider Quick Search tab.
Eligibility
All full-time employees working 75% (or 100% in the case of bus drivers) of assigned full-time position per week are eligible for coverage the first of the month following one calendar month of continuous employment.
Legally married spouses and eligible dependent children up to age 26 regardless of marital or student status are also eligible.
