Vision Benefits
Tishman will continueto provide its vision benefit through UnitedHealthcare Vision. The network is one of the nation'slargestproviders of eye care coverage with a provider network consistingofover 32,000 private practice and retail chain providers. These providers offer both eye exams and eye wear, making for a convenient, "one-stop" means of obtaining eye care. This coverage, if elected, is offered by Tish- man at no cost to you for yourself and your eligible family members. Vision Plan The Vision Plan provides you access to quality and affordable vision care coverage. This plan allows you to receive a complete eye examinationandmaterials (if needed). Youcan choose to receive care froma participating provider (in-network) or from any doctor of your choosing (out-of-network). If you decide to utilizean out-of-networkprovider, you willreceive a lesser benefit andtypically paymore out ofpocket. This plan allows for services and materialsto be obtained every 12 months basedon the last date of service.
Vision Plan Summary This chartsummarizesthebenefits provided under theVisionPlan.
UnitedHealthcare Vision Plan
Benefit Description
In-Network
Out-of-Network
Service Interval - Exams, Lenses, Frames and Contact Lenses (in lieu of lenses and frames)
Every 12 months based on last date of service
EyeExam
$10copay
Upto$40
Lenses (per pair) Single Lined Bifocal Lined Trifocal Lenticular
Up to $40 Up to $60 Up to $80 Up to$80
100% with Standard Scratch- Resistant Coating Lens Option
Covered in Full Frame: 100% Wholesale: Up to $50 Retail: Up to$130
Frames
Upto$45
ContactLenses Covered in Full Contact Lenses Medically Necessary Contact Lenses All Other Contact Lenses
Covered100%(UptoPlanLimits) Covered 100% Upto$200
Up to $200 Up to $210 Up to $200
Includes 8 Boxes of Contact Lenses
Frame Benefit: All wholesale frames less than our allowance are covered in-full at private practice providers. For any frame with a greater cost, you only pay the difference between the wholesale cost of the frame and the allowance. Additionally, you receive a retail frame allowance for frames purchased at retail chain providers. If your frame purchase exceeds the retail allowance, you will only pay the difference between the cost of the frame and the allowance. Contact Lens Benefit: Contactlensesareprovidedinlieuofeyeglasses(lensesandframe).Thecontactlensbenefitcoversin-full(afterapplicable copay)thefitting/evaluationfees, contacts (including eight boxes of disposables), and up to two follow-up visits. An allowance is applied toward the fitting/evaluation fees and purchase of contact lenses outside of our covered in-full contacts (materials copay does not apply). Toric, gas permeable, and bifocal contact lenses are all examples of contacts that are outside of our covered in-full selection. Medically Necessary Contact Lenses: Medicallynecessarycontactlensesaredeterminedattheeyecareprovider'sdiscretionforoneormoreof thefollowingconditions:following cataractsurgerywithoutintraocularlensimplant;tocorrectextremevisionproblemsthatcannotbecorrected witheyeglasses;withcertainconditionsofanisometropia;withcertain conditions of keratoconus. If an out-of-network provider considers contacts necessary, you should ask the provider to contact UnitedHealthcare concerning the reimbursement amount that the plan will provide before they purchase such contacts.
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