United Healthcare Vision Plan
(formerly Spectra)

Available to retirees and spouses of any age.

	In Network Provider	Out of Network Provider
Vision Care Services
Exam once every 12 months	You Pay $10 Co-pay	Plan Pays $40
Frames once every 24 months	Plan Pays100% up to $130 retail	Plan Pays $45
Lenses once every 12 months
Standard Single Vision	You Pay $10 Co-pay	Plan Pays $40
Standard Bifocal	You Pay $10 Co-pay	Plan Pays $60
Standard Trifocal	You Pay $10 Co-pay	Plan Pays $80
Contact Lenses
Standard
(includes disposable/frequent wear)	You Pay $10 Co-pay	Plan Pays $125
Premium	Plan Pays 100%	Plan Pays $125
(includes toric, multifocal)	up to $125
ONE YEAR ENROLLMENT IS REQUIRED

Monthly premiums for the plan:

Single......................... $7.50
Retiree +1................ $13.25
Family ...................... $21.70


Click here for the United HealthCare Brochure and Enrollment Form

Coverage will become effective the first of the month following Doyle Rowe LTD's receipt of your completed application.

Doyle Rowe LTD enrollment hotline: 1-800-564-7227

 

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