|Benefits||In-Network Benefits||Out-of-Network Reimbursement|
(once every 12 months)
|$30 co-pay||up to $40|
|Materials Co-pay1||$20 co-pay||Not applicable|
|Frames2(once every 24 months)|
|• Private Practice Provider||Covered-in-full; $50 wholesale frame allowance (approximate retail value of $120 - $150); receive wholesale price and $50 credit towards wholesale price; 30% discount applied to frame allowance coverage5||up to $45|
|• Retail Chain Provider||Covered-in-full; $150 retail frame allowance; 30% discount applied to frame allowance coverage5||up to $45|
|Eyeglass Lenses per pair (once every 12 months)|
|• Single Vision||Covered-in-full||up to $40|
|• Bifocal||Covered-in-full||up to $60|
|• Trifocal||Covered-in-full||up to $80|
|• Lenticular||Covered-in-full||up to $80|
|Standard (including scratch-resistant coating, standard/deluxe/premium/platinum progressive lenses, polycarbonate lenses, tints, UV coating, standard anti-reflective coating, photochromic, and Transitions®)||Covered-in-full||Not covered|
|Non-standard||May be available at a discount||Not covered|
|Contact Lenses3 - in lieu of eyeglasses (once every 12 monhts)|
|Covered-in-full lenses (including but not limited to Acuvue® by Johnson & Johnson, Optima® by Bausch & Lomb)||Covered-in-full after co-pay (up to 6 boxes)3 including evaluation, fitting, and up to two follow-up visits||up to $150|
|All other elective lenses (including but not limited to toric, gas permeable, and bifocal contact lenses)||Up to $150 allowance towards the fitting/evaluation fees and lenses purchase (materials co-pay does not apply)||up to $150|
|Medically Necessary4||Covered-in-full after applicable copay||up to $210|
- Materials co-pay is a single payment that applies to the purchase of eyeglass lenses and frames or contact lenses (in lieu of eyeglasses). All contact lenses must be purchased at one time.
- Receive a $50 wholesale frame allowance at a private practice provider or a $150 retail frame allowance at a retail chain provider (a corporately-owned provider that uses their own lab and materials).
- All 6 boxes of contact lenses must be purchased at one time in order to receive the full $150 in-network allowance. There is only one annual service authorization for this benefit.
- Determined at the provider’s discretion for one or more of the following conditions: following post-cataract surgery without intraocular lens implant; to correct extreme vision problems that cannot be treated with spectacle lenses; with certain conditions of anisometropia; with certain conditions of keratoconus. If your provider considers your contacts necessary, you should ask your provider to contact UnitedHealthcare Vision confirming how much of a reimbursement you can expect to receive before you purchase such contacts.
- Discount available at participating providers; verify discount on frame overage with your provider.
Note: The following services and materials are excluded from coverage under the vision care plan: post cataract lenses; non-prescription items; medical or surgical treatment for eye disease that requires the services of a physician; Workers’ Compensation services or materials; services or materials that the patient, without cost, obtains from any governmental organization or program; services or materials that are not specifically covered by the policy; replacement or repair of lenses and/or frames that have been lost or broken; and cosmetic extras, except as stated in the policy.
Important to Remember
- Benefit frequency based on last date of service.
- Your $150 contact lens allowance is applied to the fitting/evaluation fees as well as the purchase of contact lenses. For example, if the fitting/evaluation fee is $30, you will have $120 toward the purchase of contact lenses. The allowance may be separated at some retail chain locations between the examining physician and the optical store.
- Out-of-Network Reimbursement, when applicable: Receipts for services and materials purchased on different dates must be submitted together at the same time to receive reimbursement. Receipts must be submitted within 12 months of date of service to the following address: UnitedHealthcare Vision Attn. Claims Department P.O. Box 30978 Salt Lake City, UT 84130 FAX: (248) 733-6060
- UnitedHealthcare Vision has partnered with the Laser Vision Network of America (LVNA) to provide members with access to discounted laser vision correction providers. Members receive 15% off usual and customary pricing, 5% off promotional pricing at over 500 network provider locations and even greater discounts through set pricing at LasikPlus locations. For more information, call 1-888-563-4497 or visit www.uhclasik.com.
- Online ordering with a 10% discount off already low prices is available on contact lenses from Vision Direct, via www.myuhcvision.com.
- Receive a 20% discount on an additional pair of eyeglasses or contact lenses at participating providers.
To print a personalized ID card, complete the Member Login information at www.myuhcvision.com and select 'Print ID card' from the member benefits page. Use your 8-digit Duke unique ID#, with leading zeroes, your last name, and the patient’s date of birth to access the member information.