Vision Vision insurance How to calculate your frame benefit As a UnitedHealthcare vision plan member, you get an allowance that can be applied toward the retail purchase price of any frames you choose from any network provider at both private practice and retail locations. Since the frame allowance is applied to the retail price of the frame, understanding exactly how much you will pay is easy. If the frame costs less than the allowance, you have no additional out-of-pocket expense other than any applicable copayment. If you select a frame that costs more than your allowance, you will be responsible for the additional amount above the allowance, plus any applicable copayment. However, many of our providers offer an additional discount off any overage on frame prices, so your costs could be even lower. 1 Example: Cost of frames Less the retail frame allowance SUBTOTAL *Less 30% discount above frame allowance TOTAL COST FOR FRAMES $149.00 – $130.00 = $19.00 – $5.70 = $13.30 Sally selects frames that cost $149. She has a retail frame allowance of $130. We have negotiated with the provider to offer a 30% discount on material costs above the frame allowance. So Sally pays $13.30 for the cost of her frames, plus any copayments.* Questions about your plan? Visit www.myuhcvision.com or call 1-800-638-3120. 1 30% discount available at participating network provider locations. UnitedHealthcare Vision® coverage provided by or through UnitedHealthcare Insurance Company, located in Hartford, Connecticut, or its affiliates. Administrative services provided by Spectera, Inc., United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy form number VPOL.06 and associated COC form number VCOC.INT.06.TX. 100-10510 01/12 ©2012 United HealthCare Services, Inc.