At UPMC Health Plan, we have a long history of providing members with high-quality benefit plans, provider networks, and outstanding customer service. We continue that tradition with our new product — UPMC Vision Advantage. UPMC Vision Advantage offers three plan options — Basic, Standard, and Premium — and a network of credentialed vision providers, within the regions that UPMC Vision Advantage is offered.
Advantages
- You will receive outstanding customer service from UPMC Health Plan Member Advocates, who are able to answer questions about your vision benefits, as well as medical, dental, and MyFlex Advantage benefits, if applicable, by calling one number.
- You can chat online with a UPMC Vision Advantage Member Advocate regarding your vision benefits, eligibility, and claim status.
- You have access to vision benefits and information through MyHealth OnLine. If you are enrolled in our other products, UPMC Dental Advantage or MyFlex Advantage, for example, or any of our medical plans, you will be able to access information on those products as well.
- Auto-substantiated expenses for UPMC Health Plan members who use the MyFlex Advantage (FSA) program to pay for out-of-pocket vision expenses — that means less work for you.
Our Plans
UPMC Vision Advantage offers three plans to meet our clients' needs — Basic, Standard, and Premium.
| Benefit |
Basic Vision |
| |
In-Network Amount Covered
(Less Copayment1) |
Out-of-Network
Amount Reimbursed |
| Copayment1 |
$15 |
N/A |
| Examination |
100% |
$30 |
| Lenses |
| Single Vision |
Discount2 |
Not Covered |
| Bifocal |
Discount2 |
Not Covered |
| Trifocal |
Discount2 |
Not Covered |
| Polycarbonate Lens Material |
Discount2 |
Not Covered |
| Frames |
Discount2 |
Not Covered |
| Contact Lenses |
| In Lieu of Glasses |
| Contact Lens Fitting and Follow-Up |
Not Covered |
Not Covered |
| Contact Lens Material |
Not Covered |
Not Covered |
| Frequency of Service |
| Examination |
| Employee/Spouse/Adult Dependents |
24 months |
| Children (through age 18) |
24 months |
| Lenses |
| Employee/Spouse/Adult Dependents |
Not Covered2 |
| Children (through age 18) |
Not Covered2 |
| Frames |
| Employee/Spouse/Adult Dependents |
Not Covered2 |
| Children (through age 18) |
Not Covered2 |
1 A $15 copayment applies to the vision examination.
2 Members receive a 20% discount for frames and lenses for glasses only.
| Benefit |
Standard Vision |
| |
In-Network Amount Covered
(Less Copayment1) |
Out-of-Network
Amount Reimbursed2 |
| Copayment1 |
$15 |
N/A |
| Examination |
100% |
$40 |
| Lenses |
| Single Vision |
100% |
$40 |
| Bifocal |
100% |
$50 |
| Trifocal |
100% |
$75 |
| Polycarbonate Lens Material3 |
100% |
Not Covered |
| Frames |
$60 Retail Allowance plus discount4 |
$35 |
| Contact Lenses |
| In Lieu of Glasses |
| Contact Lens Fitting and Follow-Up5 |
$50 Allowance |
$40 |
| Contact Lens Material6 |
$75 Retail Allowance |
$60 |
| Frequency of Service |
| Examination |
| Employee/Spouse/Adult Dependents |
24 months7 |
| Children (through age 18) |
12 months7 |
| Lenses |
| Employee/Spouse/Adult Dependents |
24 months7 |
| Children (through age 18) |
12 months7 |
| Frames |
| Employee/Spouse/Adult Dependents |
24 months7 |
| Children (through age 18) |
24 months7 |
1 A $15 copayment applies to the vision examination.
2 Usual, customary, and reasonable as determined by UPMC Health Plan.
3 Available in-network at no charge for children under age 19.
4 Plan pays up to $60 retail value on frames. Plan will reimburse the provider 70% of the member's plan maximum for frames. The additional 30% is a contractual discount to the plan and cannot be billed to the patient. Any remainder above the patient's frame allowance is to be charged to the patient, minus a 20% discount, and can be collected at the time of service.
5 For specialty lens evaluation, the provider may bill the patient the difference between the provider’s billed charges and the plan/member allowance. Provider cannot balance bill for standard lens evaluation.
6 Plan will reimburse provider 100% of their billed charges up to the member’s maximum.
7 Additional examinations, frames, and lenses for glasses purchased prior to the next eligibility period are available at a discounted rate of 20%.
| Benefit |
Premium Vision |
| |
In-Network Amount Covered
(Less Copayment1) |
Out-of-Network
Amount Reimbursed2 |
| Copayment1 |
$15 |
N/A |
| Examination |
100% |
$40 |
| Lenses |
| Single Vision |
100% |
$40 |
| Bifocal |
100% |
$50 |
| Trifocal |
100% |
$75 |
| Polycarbonate Lens Material3 |
100% |
Not Covered |
| Frames |
$100 Retail Allowance plus discount4 |
$55 |
| Contact Lenses |
| In Lieu of Glasses |
| Contact Lens Fitting and Follow-Up5 |
$50 Allowance |
$40 |
| Contact Lens Material6 |
$100 Retail Allowance |
$80 |
| Frequency of Service |
| Examination |
| Employee/Spouse/Adult Dependents |
12 months7 |
| Children (through age 18) |
12 months7 |
| Lenses |
| Employee/Spouse/Adult Dependents |
12 months7 |
| Children (through age 18) |
12 months7 |
| Frames |
| Employee/Spouse/Adult Dependents |
12 months7 |
| Children (through age 18) |
12 months7 |
1 A $15 copayment applies to the vision examination.
2 Usual, customary, and reasonable as determined by UPMC Health Plan.
3 Available in-network at no charge for children under age 19.
4 Plan pays up to $100 retail value on frames. Plan will reimburse the provider 70% of the member's plan maximum for frames. The additional 30% is a contractual discount to the plan and cannot be billed to the patient. Any remainder above the patient's frame allowance is to be charged to the patient, minus a 20% discount, and can be collected at the time of service.
5 For specialty lens evaluation, the provider may bill the patient the difference between the provider’s billed charges and the plan/member allowance. Provider cannot balance bill for standard lens evaluation.
6 Plan will reimburse provider 100% of their billed charges up to the member’s maximum.
7 Additional examinations, frames, and lenses for glasses purchased prior to the next eligibility period are available at a discounted rate of 20%.
Out–of–Network Services
UPMC Vision Advantage encourages its members to use participating providers to maximize their benefit and minimize any out–of–network expenses.
In the event you elect to have services performed by a non-participating provider, UPMC Vision Advantage will reimburse you for eligible services up to the benefit maximum. You can call our Member Advocates at 1-888-499-6914 to have a form sent to you.
Contact Information
1-888-499-6914
Monday through Friday — 7 a.m. to 7 p.m.
Saturday — 8 a.m. to 3 p.m.
UPMC Vision Advantage
One Chatham Center
112 Washington Place
Pittsburgh, PA 15219
Members can log in to MyHealth OnLine to:
- Find a vision provider
- Review member eligibility, claims information, spending summaries, and benefits
- "Chat" online with a Member Advocate
This is a summary of the features of the UPMC Vision Advantage options. If there are any differences between the information provided in this summary and the plan documents, the plan documents will prevail. All benefits are subject to the definitions, limitations, and exclusions set forth in the plan documents.