TWU - Vision Coverage

All Support Staff and their covered dependents who participate in Columbia’s medical plan are covered by a basic vision benefit.

To search for a vision provider, log in to www.myuhcvision.com and search by name, specialty and location.

Basic Vision Coverage

Benefit: Routine Eye Exams
Choice In-Network Benefits apply to In-Network only: Adults: One exam every 12 months with a $10 copay
Child(ren):* One exam every 12 months with a $10 copay

Benefit: Lenses
Choice In-Network Benefits apply to In-Network only: Adults:** Every 24 months, $20 allowance for single lenses, $30 for bifocal, $40 for trifocal or $75 for lenticular
Child(ren):* Lenses covered in full every 12 months. More frequently if medically necessary

Benefit: Frames
Choice In-Network Benefits apply to In-Network only: Adults:** $30 allowance every 24 months
Child(ren):* Up to $100 covered in full every 12 months. Cost above $100 covered at 60%

Benefit: Contact Lenses
Choice In-Network Benefits apply to In-Network only: Adults:** $75 allowance every 24 months. Medically necessary contact lenses covered at 100% every 12 months
Child(ren):* Single purchase of a pair of contact lenses or 1 box of contact lenses per eye covered at 100% every 12 months. Up to $100 maximum out-of-network allowance. Medically necessary contact lenses covered at 100% every 12 months

^{* Child is defined as a member less than age 19.

** Available for either frames and lenses or contact lenses.}
Note: Provider might require payment in full at the time of service. The patient then submits a claim to UHC for reimbursement.

Benefit: Routine Eye Exams
Choice Plus 80 Benefits apply both In-Network and Out-of-Network: Adults: One exam every 12 months with a $10 copay
Child(ren):* One exam every 12 months with a $10 copay

Benefit: Lenses
Choice Plus 80 Benefits apply both In-Network and Out-of-Network: Adults:** Every 24 months, $20 allowance for single lenses, $30 for bifocal, $40 for trifocal or $75 for lenticular
Child(ren):* Lenses covered in full every 12 months. More frequently if medically necessary

Benefit: Frames
Choice Plus 80 Benefits apply both In-Network and Out-of-Network: Adults:** $30 allowance every 24 months
Child(ren):* Up to $100 covered in full every 12 months. Cost above $100 covered at 60%

Benefit: Contact Lenses
Choice Plus 80 Benefits apply both In-Network and Out-of-Network: Adults:** $75 allowance every 24 months. Medically necessary contact lenses covered at 100% every 12 months
Child(ren):* Single purchase of a pair of contact lenses or 1 box of contact lenses per eye covered at 100% every 12 months. Up to $100 maximum out-of-network allowance. Medically necessary contact lenses covered at 100% every 12 months

Optional Vision Plan

For enhanced vision benefits, you can elect to purchase optional UHC vision coverage in place of the basic vision coverage for you and your covered dependents. You do not have to be enrolled in a medical plan to purchase this coverage.

Monthly Contributions

Optional UHC Vision
Yourself Only: $5.23
Yourself & Child(ren): $12.11
Yourself & Spouse: $9.69
Family: $16.96

In-Network Coverage: Adults: One exam every 12 months with a $10 copay. For pregnant/breastfeeding women and individuals with diabetes, two exams every 12 months with a $10 copay
Child(ren):* One exam every 12 months plus one additional exam ages 0-12; with a $10 copay
Out-of-Network Coverage: Adults: One exam every 12 months, plan pays up to $40. For pregnant/breastfeeding women and individuals with diabetes, two exams every 12 months, plan pays up to $40 per exam
Child(ren):* One exam every 12 months plus one additional exam ages 0-12; plan pays up to $40 per exam

^{* Child is defined as a member less than age 19.}
Note: Provider might require payment in full at the time of service. The patient then submits a claim to UHC for reimbursement.

In-Network Coverage: Adults: Plan pays 100% every 12 months for single vision, lined bifocal, lined trifocal, or lenticular, including standard scratch coating. Additional costs apply for progressive lenses
Child(ren):* Plan pays 100% every 12 months for polycarbonate lenses, including standard scratch coating. Replacement frames available if prescription change of 0.5 diopter or more
Out-of-Network Coverage: Adults and Child(ren)*: Every 12 months, up to $40 allowance for single lenses, up to $60 for lined bifocal, up to $80 for lined trifocal or up to $80 for lenticular

^{* Child is defined as a member less than age 19.}
Note: Provider might require payment in full at the time of service. The patient then submits a claim to UHC for reimbursement.

In-Network Coverage: Adults and Child(ren)*: $130 allowance every 12 months. Cost above $130 may be covered at 30% at participating providers***
Out-of-Network Coverage: Adults and Child(ren)*: Up to $45 allowance every 12 months

^{* Child is defined as a member less than age 19.

*** 30% discount available at most participating provider locations (in network)—may exclude certain frame manufacturers.}
Note: Provider might require payment in full at the time of service. The patient then submits a claim to UHC for reimbursement.

In-Network Coverage: Adults and Child(ren)*: Up to 4 boxes for covered formulary contacts, including the fitting/evaluation fees and up to 2 follow-up visits covered in full. $130 allowance for non-formulary contacts, 100% for medically necessary contacts
Out-of-Network Coverage: Adults and Child(ren)*: $130 allowance for elective contacts, up to $210 allowance for medically necessary contacts

^{* Child is defined as a member less than age 19.}
Note: Provider might require payment in full at the time of service. The patient then submits a claim to UHC for reimbursement.

In-Network and Out-of-Network Coverage: Access to discounted laser vision correction through QualSight LASIK; savings of up to 35% of national average price

^{Note: Provider might require payment in full at the time of service. The patient then submits a claim to UHC for reimbursement.}

ID Card

UHC ID cards have member information for medical, vision, and prescription drug coverage. You do not need separate cards for each benefit. After enrolling in a medical plan, it can take three weeks for a UHC ID card to arrive in your mail. If necessary, you can print a temporary UHC ID card two weeks after enrolling. Create an account on myuhc.com to print a temporary ID card. Use your Social Security Number, date of birth, and Group number 712790.

TWU - Vision Coverage

Choice In-Network

Choice Plus 80

Monthly Contributions

Monthly Contributions

Routine Eye Exams

Lenses

Frames

Contact Lenses

Laser Vision Discount

Health & Welfare Benefits

Related Documents

Benefits Tools