Vision Plan Highlights: What You Pay

  Standard Plan Buy-up Plan
Vision Services In-Network Out-of-Network1 In-Network Out-of-Network1
Comprehensive Exam
(every 12 months)
$10 copay up to $40 $10 copay up to $40
Materials $25 copay See spectacle lenses and frame benefit below $25 copay See spectacle lenses and frame benefit below
Glasses Lenses*
(Every 12 months)
Standard Plan:
  • Standard Scratch-Resistant Coating

Buy-up Plan:

  • Scratch-resistant coating
  • Polycarbonate Lenses
  • Anti-Reflective
$25 copay

Amounts over:

$40 single vision
$60 bifocal
$80 trifocal
$80 lenticular

$25 copay

Amounts over:

$40 single vision
$60 bifocal
$80 trifocal
$80 lenticular

Frames
(every 24 months)
Amounts over $130 Amounts over $45 Amounts over $130 Amounts over $45
Contact Lenses**
(every 12 months)
  • Fitting/evaluation
  • Contacts
  • Two follow-up visits (after $25 copay)
Covered-in-full selection or amounts over $105

Amounts over:

$105 elective
$210 necessary

Covered-in-full selection or amounts over $105

Amounts over:

$105 elective
$210 necessary

Laser Vision*** N/A N/A N/A Lifetime Max Reimbursement of $500

1Out-of-Network Reimbursement: Receipts for service and materials purchased on different dates must be submitted together at the same time to receive reimbursement. Receipt must be submitted within 12 months of date of service to the following address: UHC Vision, ATTN: Claims Dept., P.O. Box 30978, Salt Lake City, UT 84130.

*Benefits available every 12 to 24 months (depending on the benefit frequency), based on last date of service.

**Your $105 Contact Lens allowance is applied to the fitting/evaluation fees and the purchase of the contact lenses. For example, if the fitting/evaluation fee is $30, you will have $75 toward the purchase of contact lenses. The allowance may be separated at some retail chain locations between the examining physician and the optical store. If you choose disposable contacts, you may receive up to four boxes of disposable contacts (depending on prescription). This benefit is covered in lieu of eyeglasses when obtained from a network provider. Toric, gas permeable and bifocal contacts are all examples that are outside our covered-in-full selection.

***UHC has partnered with Laser Vision Network of America (LVNA) to provide members with access to discounted laser correction providers at UHClasik.com or (888) 563-4497.