UPHS_Enrollment_Flipbook_Print_Version

For questions or to find a network provider, refer to one of these provider contacts:Provider Phone Number WebsitePENN Faculty Practice 215-898-4615 www.dental.upenn.edu/patient_careDelta Dental 800-932-0783 www.deltadentalins.comAetna DMO 877-238-6200 www.aetna.comVision BenefitsUPHSflex benefits offers three options for vision coverage. You can choose from the IBC DavisVision Premium Plan, IBC Davis Vision Standard Plan, or Vision Benefits of America (VBA) Plan.All three plans cover eye exams, standard lenses and frames, or contacts.You can also save money if you receive eye care from UPHS Eye Care Centers:PENNPresbyterianMedicalCenterScheie EyeInstitute51 N. 39th StPhiladelphia, PA19104Hospital oftheUniversity ofPennsylvania2 Gates3400 Spruce StPhiladelphia,PA19104PENNMedicine atRadnor250 King ofPrussia RdRadnor, PA19087MercyFitzgeraldMedicalOfficeBuilding1501LansdowneAveSuite 2058Darby, PA19023PENN EyeCare atMedia601 WestState StreetMedia, PA19063Low VisionResearch andRehabilitationCenter atRalston House3615 ChestnutStreetPhiladelphia, PA19104Penn Eye Careat the PerelmanCenter forAdvancedMedicine3400 Civic CenterBlvdWest Pavilion3 rd FloorSuite 3-013WPhiladelphia, PA19104215-662-2745Scheie Eye is a participating provider with both IBC Vision Plans and VBA for your routine visioncare. However, if you elect the IBC Davis Vision Premium Plan and use Scheie providers, you willreceive some enhanced vision care benefits at a reduced cost for services.IBC Davis Vision Premium PlanIBC Davis Vision Premium PlanHow to Access Care Scheie Provider All Other ParticipatingProvidersNon-ParticipatingProvidersEye Exam (once per Covered at 100% Covered after $10 copay Reimbursement of up to $32contract year)Standard Lenses Covered at 100% for all Covered at 100% for all Reimbursement of up to:(once per contract ranges of prescriptions ranges of prescriptions • Single vision: $30year)• Bifocal: $36• Trifocal: $50• Lenticular: $7214