UnitedHealthcare Vision Plan
The Plan offers in-network and out-of-network benefits. When using a participating network provider, you pay a modest copayment for exam and materials as shown in the Schedule of Benefits. The out-of-network benefit allows you to select any licensed non-network provider. As the plan participant, when visiting a non-network provider, you pay the full fee to the provider and UnitedHealthcare Vision will reimburse you for services rendered up to the maximum allowance. There are no copays or deductibles when using an out-of-network provider.
As part of your package you are entitled to receive frames. Frames are covered in full if services are rendered in-network after paying a $10 copayment. For out-of-network, we will reimburse up to $45. The in-network contact lens benefit is covered in full after paying a $10 copayment which includes the fitting/evaluation fees and up to two follow-up visits for covered contacts. For non-covered contacts, there is a $105 allowance applied toward the purchase of the contacts. Under the out-of-network contact lens benefit, we will reimburse up to $105 less any fitting/evaluation fee.
Schedule of Benefits
Covered Benefit |
In-Network |
Out-of-Network |
|
Exams – Once Every Calendar Year |
Covered in Full | Up to $40 |
| Lenses – Once Every Calendar Year | ||
| Single Vision |
Covered in full after a $10 copay
|
up to $40 |
| Bifocal | Covered in full after a $10 copay | up to $60 |
| Trifocal | Covered in full after a $10 copay | up to $80 |
|
Lenticular |
Covered in full after a $10 copay | up to $80 |
| Frames – Once Every Calendar Year | $130 retail frame allowance after a $10 copay | Up to $45 |
| Elective Contact Lenses in Lieu of glasses – Once every Calendar Year* | ||
|
Selection Contact Lenses
(Selection contact lenses refers to the UnitedHealthcare Vision formulary contact list) |
The fitting/evaluation fees, contact lenses, and up to two follow-up visits are covered in full after a $10 copay. If you choose disposable contacts, up to 4 boxes are included when obtain from an in-network provider.
|
Up to $105
|
|
Non-Selection Contact Lenses
|
$105 allowance is applied toward the purchase of contact lenses outside the selection. Material copay is waived.
|
Up to $105
|
|
Necessary Contact Lenses
|
Covered in full after a $10 copay
|
Up to $175
|
|
Lens Options
|
Standard Scratch-Resistant, Polycarbonate Lenses for Adults and Polycarbonate for Dependent Children (up to age 19) – covered in full. Other option lens upgrades may be offered at a discount (discount varies by provider).
|
Not Applicable
|
* During any plan year, you may elect either the frames and/or lenses covered service or the contact lenses allowance, but not both.
If there are any differences in this document and the Group Policy, the Group Policy is the governing document. Please consult the applicable policy/certificate of coverage for the full description of benefits, including exclusions and limitations.
Any copayment or out-of-pocket cost may be reimbursed through your Medical Expense FSA.
See the FSA section for a partial list of eligible expenses or visit TASC’s website at www.tasconline.com for the full version of eligible expenses.
Notes on the UnitedHealthcare Vision In-Network:
- The eye exam, contact lenses (new or replacement), or lenses are provided once every calendar year regardless of prescription change. Frames are provided once every calendar year.
- Your out-of-pocket cost for the service rendered is paid by you upon receipt of services. Oversize lenses, tinted lenses, sunglasses, and nonstandard and photochromatic lenses may be purchased with an additional charge. Contact lenses are in lieu of frames and lenses.
- There is no annual deductible with this plan.
How to use the UnitedHealthcare Vision In-Network Plan Benefits:
Using a Panel Eye Doctor
- A list of participating optometrists and ophthalmologists can be accessed through www.dadeschools.net. Benefits listed are valid at all participating eye doctors.
- Identification cards are not needed. Your eligibility for service is verified by identifying yourself as a UnitedHealthcare Vision Plan participant when you make an appointment with a participating eye doctor.
- Their eye doctor’s office will handle all claim forms.
Notes on the UnitedHealthcare Vision Out-of-Network Plan:
- You are responsible for payment of the entire fee. There will be a one-time reimbursement by the UnitedHealthcare Vision Plan up to the amounts listed on chart.
- The vision exam is provided once every calendar year, with a maximum $40 reimbursement.
- Lenses are provided once every calendar year, if needed, as determined by your optometrist or ophthalmologist.
- Frames are provided once every 12 months, if needed. Frames are limited to a maximum $45 benefit.
- Contact lenses will be provided once every 12 months under the plan, if needed, as determined by your optometrist or ophthalmologist. Payment will be made for only one pair of lenses, either single, bifocal, trifocal, or contacts during the calendar year. No frame or lens benefits are available during the calendar year that contact lenses are elected.
How to use the UnitedHealthcare Vision Out-of-Network Plan Benefits:
- UnitedHealthcare Vision Out-of-Network vision benefits are valid at any licensed ophthalmologists , optometrists, optometrist or optician.
- Vision claim forms will be provided upon request by UnitedHealthcare Vision at 1.800.638.3120 or can be downloaded at www.myuhcvision.com.
Plan Details
Tools and Resources
Frequently Asked Questions
Click on the question to view the answer
Can you explain the UnitedHealthcare Vision Frame Benefit?
Under the UnitedHealthcare plan, you are free to choose any frame available at any provider location, or any frame that a provider is willing to order for you. At both network retail locations and private locations, you will receive a $130 retail allowance toward the cost of the frame. If the frame falls within the allowance, it will be fully covered with no out-of-pocket expenses beyond the material copay. If you choose a frame that exceeds these allowances, you only pay the difference and may also take advantage of any provider discounts offered.
For out-of-network we reimburse up to $45.
Does the plan offer access to vision discounts?
You can save on high-quality hearing aids when you buy them from hi HealthInnovations™**. For more information, visit www.hiHealthInnovations.com or call 1.855.523.9355.
*LASIK is not a covered benefit, but a discount available to UnitedHealthcare vision members.
**The hi HealthInnovations™ hearing program is provided through UnitedHealthcare, offered to existing members of certain products underwritten or provided by UnitedHealthcare Insurance Company or its affiliates to provide specific hearing aid discounts. This is not an insurance or managed care product, and fees or charges for services in excess of those defined in program materials are the member’s responsibility. UnitedHealthcare does not endorse or guarantee hearing aid products/services available through the hearing program. This program may not be available in all states or for all group sizes. Components subject to change.
Who is an eligible dependent for this coverage?
- Spouse/Domestic Partner
- Children (including children of a Domestic Partner, as long as the Domestic Partner is also covered) will be covered under this plan until the end of the calendar year in which he/she reaches age 26. Coverage applies whether they are/are not married or a student.
Vision Plan General Exclusions
The following Services and materials are excluded from Coverage under the Policy:
- Non-prescription items (e.g. Plano lenses) other than those listed in the Schedule(s) of Covered Vision Services.
- Services that the Covered Person, without cost, obtains from any governmental organization or program.
- Services for which the Covered Person has been paid under Workers’ Compensation Law, or other similar employer liability law.
- Any eye examination required by an employer as a condition of employment, by virtue of a labor agreement, a government body, or agency.
- Medical or surgical treatment for eye disease, which requires the services of a Physician.
- Replacement or repair of lenses and/or frames that have been lost or broken.
- Optional Lens Extras not listed in the Schedule(s) of Covered Vision Services.
- Missed appointment charges.
- Applicable sales tax charged on Services.
- Services that are not specifically covered by the Policy.
- Procedures that are considered to be Experimental, Investigational or Unproven. The fact that an Experimental, Investigational or Unproven Service, treatment, device or pharmacological regimen is the only available treatment for a particular condition will not result in Coverage if the procedure is considered to be Experimental, Investigational or Unproven in the treatment of that particular condition.
- Any Vision Service rendered by the Policyholder.
- Intraocular lenses.
Customer Service:
1-800-638-3120
Mon – Fri, 8 a.m. to 11 p.m. ET
Sat, 9 a.m. to 6:30 p.m. ET
Miami-Dade County Public Schools
Office of Risk and Benefits Management
1501 N.E. 2nd Avenue, Suite 335
Miami, Florida 33132
Mon - Fri, 8 a.m. to 4:30 p.m. ET
www.dadeschools.net
Benefits Inquiry:
FBMC Service Center
Mon - Fri,
7 a.m. to 7 p.m. ET
1-855-MDC-PS4U (1-855-632-7748)
Enrollment Helpline:
1-305-995-2777
7 a.m. to 7 p.m. ET /
Seven days a week