Overview
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, UPMC Dental Advantage, 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
Contact Lenses |
Discount2 |
Not Covered |
| 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/Spoutse/Adult Dependents |
Not Covered2 |
| Children (through age 18) |
Not Covered2 |
1A $15 copayment applies to the vision examination.
2Members receive a 20% discount for lenses and frames.
| 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
Contact Lenses |
$60 Retail Allowance plus discount4 |
$35 |
| 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/Spoutse/Adult Dependents |
24 months7 |
| Children (through age 18) |
24 months7 |
1A $15 copayment applies to the vision examination.
2Usual, Customary, and Reasonable as determined by UPMC Health Plan.
3Available In-network at no charge for children under age 19.
4Plan 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.
5For 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.
6Plan will reimburse provider 100% of their billed charges up to the member's maximum.
7Additional examination, 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
Contact Lenses |
$100 Retail Allowance plus discount4 |
$55 |
| 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/Spoutse/Adult Dependents |
12 months7 |
| Children (through age 18) |
12 months7 |
1A $15 copayment applies to the vision examination.
2Usual, Customary, and Reasonable as determined by UPMC Health Plan.
3Available In-network at no charge for children under age 19.
4Plan 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.
5For specialty lens evaluation, the provide 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.
6Plan will reimburse provider 100% of their billed charges up to the member's maximum.
7Additional examination, 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. Participating providers can be located by clicking the Find a vision care provider link to the left.
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. Call our Member Advocates at 1-888-499-6914.
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.