Vision Benefits

Getting your eyes checked regularly is important even if you don’t wear glasses or contacts. We provide quality vision care for you and your family through UnitedHealthcare.

UHC VISION PLAN

Video coming soon

Premiums

Plan	EMPLOYEE + SPOUSE	EMPLOYEE + CHILD(REN)	EMPLOYEE + FAMILY
PremiumsBiweekly Contributions	$2.82	$4.20	$6.76
PremiumsWeekly Contributions	$1.41	$2.10	$3.38

Premiums

Biweekly Contributions

EMPLOYEE + SPOUSE: $2.82
EMPLOYEE + CHILD(REN): $4.20
EMPLOYEE + FAMILY: $6.76

Premiums

Weekly Contributions

EMPLOYEE + SPOUSE: $1.41
EMPLOYEE + CHILD(REN): $2.10
EMPLOYEE + FAMILY: $3.38

Employee only vision is bundled with medical and dental.

Service Frequency

Service	FREQUENCY
Exams - copay	Once every 12 months
Lenses - single vision	Once every 12 months
Lenses - bifocal	Once every 12 months
Lenses - trifocal	Once every 12 months
Contacts (in lieu of lenses and frames) - elective	Once every 12 months
Contacts (in lieu of lenses and frames) - medically necessary	Once every 12 months
Frames - allowance	Once every 12 months

Exams - copay

FREQUENCY: Once every 12 months

Lenses - single vision

FREQUENCY: Once every 12 months

Lenses - bifocal

FREQUENCY: Once every 12 months

Lenses - trifocal

FREQUENCY: Once every 12 months

Contacts (in lieu of lenses and frames) - elective

FREQUENCY: Once every 12 months

Contacts (in lieu of lenses and frames) - medically necessary

FREQUENCY: Once every 12 months

Frames - allowance

FREQUENCY: Once every 12 months

Vision Plan Summary

Service	IN-NETWORK	OUT-OF-NETWORK
Exams - copay	$10	Up to $40
Lenses - single vision	Plan pays 100%	Plan pays $40
Lenses - bifocal	Plan pays 100%	Plan pays $60
Lenses - trifocal	Plan pays 100%	Plan pays $80
Contacts (in lieu of lenses and frames) - elective	Allowance of $125	Plan pays up to $125
Contacts (in lieu of lenses and frames) - medically necessary	Covered in full	Plan pays up to $210
Frames - allowance	$130 + 30% off balance	Up to $45

Exams - copay

IN-NETWORK: $10
OUT-OF-NETWORK: Up to $40

Lenses - single vision

IN-NETWORK: Plan pays 100%
OUT-OF-NETWORK: Plan pays $40

Lenses - bifocal

IN-NETWORK: Plan pays 100%
OUT-OF-NETWORK: Plan pays $60

Lenses - trifocal

IN-NETWORK: Plan pays 100%
OUT-OF-NETWORK: Plan pays $80

Contacts (in lieu of lenses and frames) - elective

IN-NETWORK: Allowance of $125
OUT-OF-NETWORK: Plan pays up to $125

Contacts (in lieu of lenses and frames) - medically necessary

IN-NETWORK: Covered in full
OUT-OF-NETWORK: Plan pays up to $210

Frames - allowance

IN-NETWORK: $130 + 30% off balance
OUT-OF-NETWORK: Up to $45

Plan Notes

Vision premium contributions are deducted from your paycheck on a pre-tax basis. Your tier of coverage determines your premium.
Contact lenses are covered in lieu of lenses and frames: elective contacts have a $125 allowance, and medically necessary contacts are covered in full in-network.
Exams, lenses, contact lenses and frames are each available once every 12 months.