A clear-eyed choice. Plan highlights

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1 UPMC Vision Care

2 A clear-eyed choice Welcome to UPMC Vision Care. This UPMC Health Plan vision insurance product is administered by National Vision Administrators (NVA ) and comes with comprehensive member benefits and a vast network of credentialed eye doctors and eye care centers near you. You ll also get discounts on products and services that can save you money. Better still is what UPMC Vision Care can do for your eye health. A recent nationwide survey found that people with vision insurance plans are twice as likely to schedule an annual eye exam as those who do not have vision coverage. This is significant, because an eye exam is the only way to accurately check your eyesight then correct it if need be. Also, many eye diseases, such as glaucoma and diabetic eye disease, have no warning signs. An eye exam can detect these types of diseases in their early stages, when they are likely to be more treatable. That can give you serious peace of mind brought to you by UPMC Vision Care. At UPMC Health Plan, we have a long history of providing members with high-quality benefit plans, provider networks, and outstanding customer service. The tradition continues with UPMC Vision Care, which offers hybrid-lab PPO plan designs and a large network of providers to choose from. Plan highlights Outstanding customer service from our Health Care Concierge team. Our team members are dedicated to answering questions about your vision benefits as well as your medical, UPMC Dental Advantage, and UPMC FlexAdvantage benefits (if applicable). Receive a discount benefit through the NVA EYEESSENTIAL TM Plan. This includes discounts on exams, lenses, additional lens options, frames, and contact lenses. *Some restrictions may apply. Log in to MyHealth OnLine to quickly access your vision benefits and information. It s also easy and convenient to view information on other plans you may be enrolled in, such as UPMC Dental Advantage, UPMC FlexAdvantage, or any of our medical plans. Access to a mail-order contact lens ordering service.

3 Using your vision benefits With UPMC Vision Care, you may receive*: Discounted rates for various extras, including lens and frame add-ons and additional exams when you use a participating provider. Discounts on frames and contact lenses when you use a participating provider. A separate benefit allowance for contact lens evaluation. The option to select contact lenses instead of glasses. *Please refer to your plan documents. NOTE: UPMC Vision Care does not cover certain items and services as outlined in your Certificate of Insurance. These include but are not limited to medical treatment of eye disease or injury, vision therapy, special lens designs or coatings (unless otherwise stated), nonprescription lenses, and services not performed by a licensed professional. To receive services from a UPMC Vision Care provider: Contact your provider to schedule an appointment. Notify your provider that you are a UPMC Vision Care member. Provide the office with the subscriber s name and date of birth as well as the name of the member receiving care. The provider will verify eligibility for services. ID cards are not required for treatment, but are available to you as a new member for your convenience. If lost or stolen, additional cards will not be sent out. However, you may download and print a replacement card by visiting MyHealth OnLine. As a UPMC Vision Care member, you will have instant access to your up-to-date eligibility, benefits, and claims information at MyHealth OnLine. Simply follow this path: MyHealth OnLine > Coverage and Benefits > Your Benefits > Vision Coverage Out-of-network services UPMC Vision Care encourages you to use participating providers to maximize your benefits and minimize expenses. You can locate participating providers by going to then clicking on the Doctors icon and selecting Vision. However, if you decide to get services from a nonparticipating provider, UPMC Vision Care will reimburse you for eligible services up to the benefit maximum. You can download an out-of-network reimbursement form from our website at or call your Health Care Concierge team at to have a form sent to you. For care outside Pennsylvania UPMC Vision Care offers a national network of providers for members residing or traveling outside Pennsylvania. To locate a participating out-of-area provider, please visit our website at or call your Health Care Concierge team at for assistance.

4 LASIK discounts For UPMC Vision Care members, special discounts are available on LASIK procedures at the locations listed below. To use your discount, mention that you are a UPMC Vision Care member when contacting your preferred LASIK location. UPMC Eye Centers The discount: Receive a free initial screening as well as a 20 percent discount on vision correction procedures performed by UPMC s internationally renowned refractive surgeons. Additional discounts apply when the procedures are performed by the Center s Cornea Fellow. Contact information: To find out if you are a candidate for vision correction, call to schedule a free consultation. QualSight LASIK The discount: QualSight offers the following discounts: $945 per eye for Traditional LASIK; $1,370 per eye for Custom LASIK; and $1,770 per eye for Custom Bladeless. Your preoperative appointment, the LASIK procedure, postoperative visits and a One-Year Assurance Plan are included in the price. (Lifetime Assurance Plans are also available through participating providers.) Contact information: Call a QualSight LASIK Care Manager at Monday through Friday from 7 a.m. to 7 p.m. or Saturday from 8 a.m. to 4 p.m. Or visit TLC Vision locations, including TLC Laser Eye Centers in Pittsburgh The discount: Savings on LASIK, including a free consultation, pre- and postoperative care, the LASIK procedure, and the TLC Lifetime Commitment. Contact information: For your free consultation, call or toll-free You can also book online at: LASIK Centers of America (LCA) The discount: LCA has over 580 locations nationwide. All in-network providers are contracted to extend the following discounts: 15 percent off standard prices or five percent off promotional prices. An extra value can be obtained if a LasikPlus provider is utilized. Discounts at these locations include special prices from $695 to $1,895 per eye, a free LASIK exam, bladeless procedures, and free enhancements for life on most treatments. Contact us If you have questions or would like more information about UPMC Vision Care, call us toll-free at , Monday through Friday from 7 a.m. to 7 p.m. or Saturday from 8 a.m. to 3 p.m. Or you can log in to MyHealth OnLine 24/7 by first going to Here you can: Find a vision provider. Review member eligibility, spending summaries, and benefits. View vision wellness information. Check frame inventory. Chat online with a Health Care Concierge. IMPORTANT: If you are a UPMC Health Plan medical member, do not present your medical ID card as proof of vision insurance. This is a summary of the features of the UPMC Vision Care options. If there are any differences between the information provided in this summary and the plan documents, the plan documents will prevail. All benefits are subject to the definitions, limitations, and exclusions set forth in the plan documents.

5 Frequently asked questions Q: Where can I find vision providers who participate in the UPMC Vision Care network? A: A complete listing is available at MyHealth OnLine. Go to log in to MyHealth OnLine, click on the Doctors icon, then select Vision. You can search by name, office location, ZIP code, and vision provider profile. You can also call us toll-free at and we can help you find a provider. Q: What if my provider is not in the UPMC Vision Care network? A: UPMC Vision Care offers coverage for out-ofnetwork care. However, you have reduced benefits and your vision provider may bill you for the difference between his or her charge and the amount paid by the plan. To receive the maximum reimbursement, we strongly encourage you to select a participating vision provider for all of your vision services. You can also ask your vision provider to join the UPMC Vision Care network. Q: How can my vision provider join the UPMC Vision Care network? A: By calling National Vision Administrators at Q: How can I access and review my vision benefits and payments? A: You can review your information by visiting then following this path: MyHealth OnLine > Coverage and Benefits > Your Benefits > Vision Coverage. Q: Will I be required to select frames from the eye care store displays? A: Depending on your specific plan, you may not be limited to a specific selection of frames. However, you should refer to your plan documents for details. Q: If I live or work outside of Pennsylvania can I still receive UPMC Vision Care services? A: Yes. UPMC Vision Care offers coverage for members residing or traveling outside of Pennsylvania through the use of our national network. To find a provider that is out-of-area, visit log in to MyHealth OnLine, click on the Doctors icon, then select Vision. Q: Do I need an ID card in order to use my vision benefits? A: UPMC Vision Care ID cards are not required for treatment, but for your convenience, an ID card will be sent to you when you enroll. You can also print a UPMC Vision Care ID card by visiting logging in to MyHealth OnLine, and following the steps below. After logging in to MyHealth OnLine, select Coverage and Benefits on the left-hand side of the page. Select Print or Order and ID Card. Click on the Print ID Card icon next to the name of the person you are printing an ID card for.

6 U.S. Steel Tower, 600 Grant Street Pittsburgh, PA Copyright 2015 UPMC Health Plan Inc. All rights reserved. VISION CARE GDE 15OP0298 (SHD) 8/21/15

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