2012 Benefit Enrollment Guide - Education Management Corporation

Vision Benefits Summary
Benefit
Benefit Period
In Network
Premium Plan
12 month period from last date of service
Out of Network
Vision Exams
(one every 12 months)
100%
Up to $60
Lenses*
(once every 12 months)
Single Vision
100% $40 allowance
Bifocal
100% $60 allowance
Trifocal
100% $80 allowance
Lenticular
100%
$80 allowance
Polycarbonate
100%
Not Covered
Scratch-Resistant Coating
100%
Not Covered
Frames
(once every 12 months)
$130 $50
Contact Lenses
(once every 12 months)
Elective-covered in full**
100%
$150
Elective-specialty***
$150 $150
Medically Necessary****
100%
$250
Laser Vision Correction
Access to discounted laser vision correction procedures from numerous provider locations throughout the U.S. To find
a participating laser vision correction surgeon in your area, visit www.myuhcvision.com or call 1-877-28-SIGHT.
****One pair of standard single vision, lined bifocal, lined trifocal or standard lenticular lenses is covered in full. Options, such as progressive lenses, tints,
UV, and anti-reflective coating may be available at a discount.
****The fitting/evaluation fees, contacts (including disposables) and up to two follow-up visits are covered in full (after the applicable co-pay) for many of the
most popular brands on the market. If covered disposable contact lenses are chosen, up to 6 boxes (depending on your prescription) are included when
obtained from a network provider. UnitedHealthcare Vision’s covered-in-full contact lenses may vary by provider.
****Toric, gas permeable, and bifocal contacts are examples of contacts that are outside of the “covered-in-full” category.
****Necessary contact lenses are 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 corrected with spectacle lenses and with certain conditions of anisometropia
or keratoconus. If your provider considers your contacts necessary, ask your provider to contact UnitedHealthcare Vision concerning the reimbursement
that UnitedHealthcare Vision will make before you purchase such contacts.
The chart shown above represents an overview of the covered services and plan limitations within each of the vision plan categories. The above overview is not a
complete description. The UnitedHealthcare Vision contract and benefit booklet for the plan will govern if any discrepancies exist between this overview and the
contract and/or actual benefit booklet.
Questions? Contact HR One Connect at 1.888.471.3362 (1.888.HR1.EDMC).
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