Questions? Contact HR One Connect at 1.888.471.3362 (1.888.HR1.EDMC).
Polycarbonate
100%
100%
$80 allowance
Lenticular
Not Covered
100%
100%
100%
$150
$150
$150
$250
$130
$50
Not Covered
Scratch-Resistant Coating
Frames
(once every 12 months)
Contact Lenses
(once every 12 months)
Elective-covered in full**
Elective-specialty***
Medically Necessary****
Laser Vision Correction
Access to discounted laser vision correction procedures from numerous provider locations throughout the U.S. To f
a participating laser vision correction surgeon in your area, visit
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 l
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)
most popular brands on the market. If covered disposable contact lenses are chosen, up to 6 boxes (depending on your prescription) are
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
intraocular lens implant, to correct extreme vision problems that cannot be corrected with spectacle lenses and with certain conditions o
or keratoconus. If your provider considers your contacts necessary, ask your provider to contact UnitedHealthcare Vision concerning the
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 ov
complete description. The UnitedHealthcare Vision contract and benefit booklet for the plan will govern if any discrepancies exist between this ove
contract and/or actual benefit booklet.