Optometrists are medical professionals for the eye. They can:
- Examine, diagnose, treat and manage diseases, injuries, and disorders of the eye and associated structures.
- Identify related conditions affecting the eye.
- Prescribe medications.
- Provide low vision rehabilitation and vision therapy.
- Offer vision services such as eye exams.
- Prescribe eye glasses and contact lenses as needed.
Ophthalmologists are medical and surgical physicians who treat eye problems. They can:
- Provide complete eye care as listed above.
- Do surgical procedures for cataracts, glaucoma, eye trauma, and other conditions.
Our members can self-refer to participating ophthalmologists or optometrists for a routine eye exam. If a UPMC for You member needs to see an ophthalmologist for a problem, he or she must get a referral from their primary care practitioner (PCP).
UPMC for You vision benefits are administered through Envolve Vision. A list of participating vision providers is available on the Envolve Vision provider search page.
For members age 21 and older:
- Routine vision exams twice a year
- $100 allowance toward eyeglasses (one frame and two lenses) or toward one pair of contact lenses and fitting per year*
- Glasses or contact lenses to treat cataracts or aphakia (medical condition)
- Specialist eye exam with referral from PCP
For members under the age of 21:
- Routine vision exams twice a year, or more often if medically necessary
- $100 allowance toward eye glasses or toward one pair of contact lenses and fitting*
- Two frames and four lenses per year. (Note: The second pair of glasses are available if medically necessary, for example, your prescription changes.) Exception to limits can be made if medically necessary with written documentation
- Replacement of eye glasses or contact lenses if they are broken or lost, or if prescription changes, provided written documentation of the necessity of the service is submitted by the provider
- Eyeglasses and all other vision services deemed medically necessary, provided written documentation of the necessity of the service is submitted by the provider
*If you choose standard eyeglasses or contact lenses that are within the allowance, there is no cost to you. If you exceed the allowance, you will be responsible for any cost over the $100.
Members who need help finding an eye care provider, or have questions about their vision benefit, can call Envolve Member Services at 1-866-458-2138. TTY users should call toll-free 1-800-361-2629. Representatives are available Monday through Friday from 8 a.m. to 7 p.m.
For more information on vision services, view the UPMC for You Member Handbook.