Get answers.
Get answers to common member questions.
Q:
Will I use my health plan ID card when I take my 8-year-old to the eye doctor?
A: A vision ID card for pediatric vision members (generally those under age 19) can be
printed from our member website, myuhcvision.com. The card will include all the
contact information your provider will need to verify eligibility and benefits.
Q: Where can I find a list of available providers?
A: You can sign on to myuhc.com®, your health plan website. Select Physicians & Facilities.
Click on Find Vision Care, where you can search for vision providers in the network.
Q: I’m over the age of 19 and don’t have children. Am I required to have pediatric
vision benefits?
A: Yes, the law requires that pediatric vision services be covered as EHB in all small group
and individual health plans. The good news is that UnitedHealthcare health plans include
these benefits in a cost-effective way. A person over the age of 19 wouldn’t be eligible
for vision coverage unless he or she purchased stand-alone vision coverage. We would
encourage him or her to obtain stand-alone coverage.
Q: I have a 21-year-old son and a 16-year-old daughter. Should I also purchase a
separate vision plan to supplement the pediatric vision benefits for my family?
A: A full-family vision plan can supplement the coverage in the health plan for your
daughter and provide coverage for you and your son, who is over the age of 19.
Some states cover children up to the age of 21. In these states, both children will
be covered for pediatric vision services under your health plan.
Q: Will pediatric vision services apply to my health plan deductible and
out-of-pocket maximum?
A:
Any costs for services that are covered by your health plan will apply to the plan’s
out-of-pocket maximum, which includes copays, deductible and coinsurance payments.
UnitedHealthcare vision coverage provided by or through UnitedHealthcare Insurance Company, located in Hartford,
Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates.
Administrative services provided by Spectera, Inc., United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use
policy form number VPOL.06.TX or VPOL.13.TX and associated COC form number VCOC.INT.06.TX or VCOC.CER.13.TX.
Plans sold in Virginia use policy form number VPOL.06.VA or VPOL.13.VA and associated COC form number VCOC.INT.06 VA
or VCOC.CER.13.VA.
MT-1169060 3/18 ©2018 United HealthCare Services, Inc. 100-13344 18-7415
To learn more
• Contact your UnitedHealthcare representative today.
• Visit uhc.com/reform, our United for Reform Resource Center.
Pediatric Vision Essential
Health Benefit Guide.
1
Understand the basics.
2
Get the facts.
3
Get answers.
3 Pediatric Vision Essential Health Benefit GuideLearn more at uhc.com/reform 4
The Affordable Care Act (ACA) requires that specific Essential Health Benefits (EHB)
be covered under health plan offerings for individuals and small groups*. Pediatric
vision services, generally for those up to the age of 19, is an EHB.
Larger groups are not required to offer EHB, but if vision services are included in the
health plan, certain rules may apply.
What’s covered and how?
How does this impact you?
Q: What pediatric vision services are required to be covered as an EHB?
• Annual routine vision examinations.
• Glasses, including lenses and frames.
• Contact lenses (in place of glasses).
A: Plan designs may vary by state and health plan selected. Consult your
UnitedHealthcare representative for more information about the health plan
you are considering.
Q:
Are some pediatric vision services designated “preventive” by the ACA?
A: The ACA didn’t designate pediatric vision services as a preventive care service.
As a result, these services may be covered before or after the health plan
deductible is met.
Q:
Do all small group medical policies have to include pediatric vision EHB?
A: Yes, since pediatric vision services is one of the 10 essential health benefits
required by the ACA for all individual and small group medical plans.
Q: Should families purchase a separate vision plan to supplement the pediatric
vision benefits provided in the health plan?
A: Health plan designs will vary by state, market and carrier. Families that want vision
coverage for adults should consider signing up for a traditional, full-family vision
plan. That way, adults will have coverage for services like routine exams and eye
wear. Plus, it will provide additional coverage for pediatric vision services.
Understand the basics
about the pediatric vision
Essential Health Benefit.
*The definition of small group varies by state.
Get the facts.
Get “behind the buzz” with facts
.
The buzz.
Your employees have a
smaller vision network when
vision is embedded in the
medical policy.
The facts.
With UnitedHealthcare, this is simply not accurate. Our
vast national vision network includes both private practice
and national retail chains. All members who may receive
vision benefits provided through the health plan will access
the same large national and local network. Not only does
this provide all members of the family with access to a large
vision provider network, it also provides consistency for all
family members to have access to the same providers.
The buzz.
All pediatric vision EHB gets
applied to the health plan
out-of-pocket maximums.
The facts.
That’s correct. All pediatric vision EHB will apply directly
to the health plan’s out-of-pocket maximums. This helps
those with high-deductible health plans meet their
maximum sooner.
The buzz.
Small group employers don’t
need to do anything to comply
with the Affordable Care Act
(ACA). The responsibility is on
the employee.
The facts.
That isn’t correct. These employers must offer certified
health plans that include the pediatric vision EHB.
The buzz.
The stand-alone vision plan
that my group has had for
many years includes coverage
for children, so it fulfills the
requirement for pediatric
vision coverage.
The facts.
Your previous plan may have included benefits for those
under the age of 19, but standard vision plans do not
qualify as certified plans, nor do any of the historical
plans offered by any vision insurance carrier. In order to
meet the requirements of the ACA, these benefits must
be offered through a medical plan.
Why is a UnitedHealthcare health plan a good choice for your pediatric
vision EHB?
1. Any EHB vision costs paid by the member are applied to the health plan
deductible and out-of-pocket maximum.
2. If you also offer a stand-alone family vision plan from UnitedHealthcare, you’ll
have consistent network access for the entire family. Both vision and health
plan members will have access to our large national and regional networks.
