2024 Benefits Booklet

United Healthcare Vision

TABLE OF CONTENTS WELCOME..............................2 WHAT’S NEW........................3 HOW TO ENROLL......... 4-5 MEDICAL......................... 6-13 PRESCRIPTION DRUG.............................. 14-15 ADDITIONAL MEDICAL PLAN RESOURCES............... 16-18 DENTAL......................... 19-20 VISION....................................21 LIFECENTER........................22 LIFE INSURANCE.............23 DISABILITY..........................24 VOLUNTARY OFFERINGS................. 25-28 SPENDING ACCOUNTS.........................29 RETIREMENT BENEFITS..............................30 CONTACTS.................. 31-32

! ATLANTICARE OPTOMETRY SERVICES AtlantiCare Physician Group PA AtlantiCare Optometry offers a full scope of optometry services to include: • Eye exams and vision tests • Prescribing and fitting new eyeglasses and contact lenses • Monitoring eye conditions related to disease like diabetes • Managing and treating conditions like dry eye and glaucoma

Your vision is important to your health. Whether yours is 20/20 or less than perfect, everyone should receive regular vision care. Regardless of your medical plan option, you may enroll in the United Healthcare Vision program. After a copay, this plan will pay for some vision services in full every 12 or 24 months, as long as you receive your vision services from a network provider. Visit myuhcvision.com to print a member ID card, verify benefits/ eligibility and to locate a provider. Here is your cost depending on your coverage level: Employee Only...................................................................... $2.20 per pay Employee and Spouse..................................................... $3.99 per pay Employee and Family....................................................... $6.78 per pay

Ready to see an optometrist? APG Optometry Mays Landing 5401 Harding Highway, Suite 2 Mays Landing, New Jersey 08330 609-833-4433 *Participating Provider in the United Health Care Vision Plan

Visit https://www.myuhcvision.com/MWP/Landing to obtain plan design information and to view provider access.

VISION PLAN COVERAGE

In-Network

Out-Of-Network

General Laser Surgery Discount Benefit Frequency Exams Lenses Frames Standard Plastic Lenses Single Bifocal Trifocal Standard Progressive Routine Exams

Covered

Not Covered

Every 12 months Every 12 months Every 24 months

Every 12 months Every 12 months Every 24 months

Covered 100% after $10 copay

Plan provides a $40 allowance

Covered 100% after $25 copay Covered 100% after $25 copay Covered 100% after $25 copay Covered 100% after $55 copay

Plan provides a $60 allowance Plan provides a $80 allowance Plan provides a $80 allowance Not Covered

Contact Lens Benefit Elective Contacts in Lieu of Eyeglasses Necessary Contacts in Lieu of Eyeglasses

To learn more about your Wellness Benefits scan here:

Plan provides $130 allowance Covered 100% after $25 copay

Plan provides up to $130 allowance Plan provides up to $210 allowance

Lens Options Tint Scratch Resistant Coating Polycarbonate - Child Polycarbonate - Adult

Covered 100% after $14 copay Covered 100% Covered 100% Covered 100% after $33 copay

Not Covered Not Covered Not Covered Not Covered

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