BenefitsIn-Network BenefitsOut-of-Network Reimbursement
Vision Exam
(once every 12 months)
$20 co-payup to $40
Materials Co-pay1$20 co-payNot applicable
Frames2(once every 24 months)  
  • Private Practice ProviderCovered-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 ProviderCovered-in-full; $150 retail frame allowance; 30% discount applied to frame allowance coverage5up to $45
Eyeglass Lenses per pair (once every 12 months)  
  • Single VisionCovered-in-fullup to $40
  • BifocalCovered-in-fullup to $60
  • TrifocalCovered-in-fullup to $80
  • LenticularCovered-in-fullup to $80
Lens Options  
Standard (including scratch-resistant coating, standard/deluxe/premium/platinum progressive lenses, polycarbonate lenses, tints, UV coating, anti-reflective coating, photochromic, and Transitions®)Covered-in-fullNot covered
Non-standardMay be available at a discountNot covered
Contact Lenses3 - in lieu of eyeglasses (once every 12 months)  
Covered-in-full lenses (including but not limited to Acuvue® by Johnson & Johnson, Optima® by Bausch & Lomb)Covered-in-full (up to 6 boxes)3 including evaluation, fitting, and up to two follow-up visitsup 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 Necessary4Covered-in-full after applicable copayup to $210
  1. 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.
  2. 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).
  3. 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.
  4. 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.
  5. 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.