Vision Coverage

UPMC for You vision benefits include vision coverage for routine eye exams and eyewear. Our members can qualify for a routine vision allowance that applies towards eyeglasses, lenses, frames, or contact lenses.

Vision Services

For members age 21 and older:

• One exam every 180 days (more often if medically necessary)
• $100 allowance toward eyeglasses or contact lenses
• Glasses or contact lenses to treat cataracts or aphakia (medical condition)
• Specialist eye exam with referral from PCP

For members younger than age 21:

• 2 exams per calendar year
• $100 allowance towards eyeglasses or contact lenses and fitting
• One pair of glasses (one frame and 2 lenses) per visit, up to 2 pairs per year if medically necessary or contact lenses and fitting
• Replacement of eyeglasses 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

Members who need help finding an eye care provider, or have questions about their vision benefit, can call Vision Member Services at 1-866-458-2138 (TTY: 711). 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.

Vision Providers

Optometrists

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

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 provider (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.

Your managed care plan may not cover all your health care expenses. Read your member handbook carefully to determine which health care services are covered.