(Hourly) 2019 McKibbon Benefit Guide

VISION INSURANCE

McKibbon Hospitality offers vision coverage through United Healthcare. The United Healthcare vision plan allows you the flexibility to see any provider. To search in-network providers visit www.myuhcvision.com and search based on your location. When you utilize an out-of-network provider you pay expenses at the time of service and file a claim for reimbursement. Below is a list of the reimbursement schedule.

Vision

In-Network

Routine Eye Exams

Every 12 months

$10 Copay

Lenses 2

Every 12 months

Single Vision Bifocal Trifocal Lenticular

$25 Copay Lens upgrades are available from 20%-60% of retail pricing.

Frames

Every 12 months

$25 Copay provides a $130 allowance PLUS 30% off cost over the allowance

Contact Lenses (in lieu of glasses)

Every 12 months

Elective Contact Lenses Selection Non-Selection

$25 Copay provides up to 4 boxes $25 Copay provides a $130allowance

Medically Necessary

Covered 100% after $25 Copay

Out-of-Network 1

Routine Eye Exams

Every 12 months Reimbursed up to $40 Every 12 months Reimbursed up to $40 Reimbursed up to $60 Reimbursed up to $80 Reimbursed up to $80 Every 12 months Reimbursed up to $45 Every 12 months Reimbursed up to $130 Reimbursed up to $210

Lenses 2 Single

Bifocal Trifocal Lenticular

Frames

Contact Lenses (in lieu of glasses) Elective Medically Necessary

Bi-Weekly Cost for Coverage

Employee Only

$3.12

Employee + Spouse

$5.92

Employee + Child(ren)

$6.94

Employee + Family

$9.77

1 Reimbursable amount, less applicable copay. 2 Lenses benefit listed are for a pair of lenses.

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