City of Athens 2023 Enrollment Guide.pptx

VISION INSURANCE
CARRIER: UNITEDHEALTHCARE
● You will pay less out of pocket when you choose an in-network provider.
● Locate an in-network provider at www.myuhcvision.com.
● You must submit a claim form for out-of-network expenses.
● LASIK surgery discounts available
ELECTION
MONTHLY
DEDUCTION
1ST & 2ND PAY PERIOD
DEDUCTION
Employee Only $7.27 $3.64
Employee + 1 $13.08 $6.54
Employee + Family $20.34 $10.17
COVERED BENEFITS IN-NETWORK OUT-OF-NETWORK
Eye Exam Copay (every 12 months)
Materials Copay
Lenses (every 12 months)
$10 copay
$25 copay
Single: Covered in Full
Bifocal: Covered in Full
Trifocal: Covered in Full
Lenticular: Covered in Full
Up to $40
N/A
Single: Up to $40
Bifocal: Up to $60
Trifocal: Up to $ 80
Lenticular: Up to $80
Frames (every 12 months) $150 retail allowance + 30% off balance Up to $45.00
Contact Lenses (every 12 months)
Formulary
Non-Formulary
Medically Necessary
If you choose disposable contacts up to
6 boxes from in-network provider
$150 allowance
Covered in full after copay
Up to $105
Up to $105
Up to $210
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