Vision benefits and coverage - UMP and VSP

2022 UMP vision benefits

 Vision care (diseases and disorders of the eye)

Your UMP vision benefits pay for covered services under the medical benefit for the treatment of diseases and disorders of the eye that are not part of routine eye exams. Regence BlueShield administers medical benefits for the treatment of diseases and disorders of the eyes.

You pay the standard rate under the medical benefit for treatment of diseases and disorders of the eye that are not part of a routine vision exam. Orthoptic therapy is not covered except for the diagnosis of strabismus, a muscle disorder of the eye. LASIK surgery is not covered. Following cataract surgery, vision hardware (contact lenses or eyeglasses, including frames and prescription lenses) is covered and paid at the standard rate.

When you have questions about treatment of diseases and disorders of the eyes call UMP Customer Service or reference your plan's 2022 certificate of coverage on the HCA website.

 Routine vision

Vision coverage is provided by UMP, in collaboration with Regence Choice Vision Plan administered by Vision Service Plan (VSP). VSP administers benefits for routine eye exams and hardware (prescription lenses, frames, or prescription contact lenses) and provides claims administration for this plan.

If you have questions about routine eye exams and hardware, call VSP Member Services.

For full details about your UMP vision benefits, read your plan’s 2022 certificate of coverage.

 Routine vision for adults (ages 19 and over)

Vision exam

Vision exam: With VSP coverage, your plan covers one professional, comprehensive routine eye examination with refraction or visual analysis per calendar year, including:

  • Prescribing and ordering proper lenses;
  • Verifying the accuracy of the finished lenses; and
  • Progress or follow-up work as necessary.

When you see a VSP Choice network provider you pay $0 of the allowed amount.

When you see an out-of-network provider you pay 100% of the billed charges. You will be reimbursed up to $45 when you submit a claim for covered services.

When you receive services outside the country, you pay 100% of the billed charges. You will be reimbursed up to $80 when you submit a claim for covered services.

Vision hardware

Lenses for glasses: The plan covers one set of prescribed glass or plastic lenses once every two calendar years:

  • When you see a VSP Choice network provider you pay $0 of the allowed amount for one set of covered glass or plastic single vision lenses, lined bifocal lenses, lined trifocal lenses, lenticular lenses, or standard progressive lenses. Impact-resistant coating is covered for dependent children ages 19 and over only.
  • When you see an out-of-network provider you pay 100% of the billed charges. When you submit a claim for covered lenses, you will be reimbursed up to the out-of-network provider limit:

    • $30 single vision lenses
    • $50 lined bifocal/standard progressive lenses
    • $65 lined trifocal lenses
    • $100 lenticular lenses
  • When you receive services outside the country, you pay 100% of the billed charges. When you submit a claim for covered lenses, you will be reimbursed up to:
    • $70 single vision lenses
    • $80 lined bifocal/standard progressive lenses
    • $90 lined trifocal lenses
    • $125 lenticular lenses

Frames: The plan covers one frame every two calendar years,

  • When you see a VSP Choice network provider, the plan pays up to $150 for covered frames.
  • When you see an out-of-network provider you pay 100% of the billed charges. You will be reimbursed up to $70 when you submit a claim for covered frames.
  • When you see a VSP approved wholesale/retail vendor, the plan pays up to the VSP approved wholesale/retail limit of $80 for covered frames. VSP approved wholesale/retail vendors include both community-based providers, as well as national retail chains. For a list of wholesale/retail vendors, contact VSP Member Services at 1 (844) 299-3041. Deaf, DeafBlind, Late Deafened and Hard of Hearing members call 1 (800) 428-4833.
  • When you receive services outside the country you pay 100% of the billed charges. When you submit a claim, you will be reimbursed up to $150.
  • When you see a VSP Choice network provider, the plan pays up to $150 for covered frames.
  • When you see an out-of-network provider you pay 100% of the billed charges. You will be reimbursed up to $70 when you submit a claim for covered frames.
  • When you see a VSP approved wholesale/retail vendor, the plan pays up to the VSP approved wholesale/retail limit of $80 for covered frames. VSP approved wholesale/retail vendors include both community-based providers, as well as national retail chains. For a list of wholesale/retail vendors, contact VSP Member Services at 1 (844) 299-3041. Deaf, DeafBlind, Late Deafened and Hard of Hearing members call 1-800-428-4833.
  • When you receive services outside the country you pay 100% of the billed charges. When you submit a claim, you will be reimbursed up to $150.

Contact lenses: The plan covers elective contact lenses or necessary contact lenses in lieu of frames and lenses once every two calendar years.

When you see a VSP Choice network provider:

  • The plan pays up to $150 for elective contact lenses. You are responsible for paying a $30 copay when you receive contact lens evaluation and fitting exam at the time of service. The plan pays 100 percent of the allowed amount for necessary contact lenses. You are responsible for paying a $30 copay when you receive contact lens evaluation and fitting exam at the time of service.

When you see an out-of-network provider you pay 100% of the billed charges. When you submit a claim, you will be reimbursed up to the following amounts:

  • $105 for elective contact lenses, including any fitting/evaluation services
  • $210 for necessary contact lenses, including any fitting/evaluation services

When you receive services outside the country, you pay 100% of the billed charges. When you submit a claim, you will be reimbursed up to the following amounts:

  • $150 elective contact lenses including any fitting/evaluation services
  • $150 necessary contact lenses including any fitting/evaluation services

Get the most out of your UMP vision benefits and save money with a VSP Choice network provider. The below VSP coverage table applies to adults and dependents ages 19 and over.

 Routine vision for children (under the age of 19)


Vision exam: The plan covers one professional comprehensive routine eye examination with refraction or visual analysis per calendar year, including:

  • Prescribing and ordering proper lenses;
  • Verifying the accuracy of the finished lenses; and
  • Progress or follow-up work as necessary.

When you see a VSP Choice network provider you pay $0 of the allowed amount.

Note: Out-of-network providers are not covered.

Lenses for glasses: With VSP coverage, you will pay $0 of the allowed amount when you see a VSP Choice network provider once every calendar year for one set of covered glass or plastic lenses: single vision lenses, lined bifocal lenses, lined trifocal lenses, lenticular lenses, standard progressive lenses, or lens enhancements of scratch-resistant coating, ultraviolet (UV) protected lenses, or impact-resistant coating.

Note: Services and supplies are not covered when you see an out-of-network provider.

Frames: You will pay $0 of the allowed amount for one covered frame every calendar year when you see a VSP Choice network provider.

Note: Services and supplies are not covered when you see an out-of-network provider.

Contact lenses: You pay $0 of the allowed amount for elective contact lenses or necessary contact lenses in lieu of frames and lenses once every calendar year when you see a VSP Choice network provider. You pay $0 for contact lens evaluation and fitting exam when you see a VSP Choice network provider.

Note: Out-of-network providers are not covered.

For full vision benefit details read your plan’s 2022 certificate of coverage on the HCA website.

Get the most out of your UMP vision benefits and save money with a VSP Choice network provider. The below VSP coverage table applies to children under the age of 19.

 Finding a routine vision provider

Get the most out of your UMP vision benefits and save money with a VSP Choice network provider. As a UMP member, you may search for a VSP Choice network provider for preventive (routine) vision services through the VSP website.

You can also search by signing in to your Regence account, selecting "Find a Doctor", and selecting "Vision". Members under the age of 19 do not have out-of-network provider benefits.

  • VSP Choice network provider: When you choose to see a VSP Choice network provider for covered preventive vision care, you pay $0 of the allowed amount. Select a VSP Choice network provider who participates in the Premier Program to receive the best value for lenses and frames or contact lenses. VSP providers who participate in the Premier Program provide access to special offers and savings.
  • Out-of-network provider: For members ages 19 and over, out-of-network providers will cost you more. Members under the age of 19 do not have out-of-network benefits.

Once you are on the VSP "Find an Eye Doctor" webpage, go to the Advanced search and select Choice Network.

If you are a UMP member who cannot find a VSP doctor within a 25-mile radius, follow these steps:

  1. Call VSP Member Services at 1 (844) 299-3041 for assistance. Deaf, DeafBlind, Late Deafened, or Hard of Hearing members, call 1 (800) 428-4833. The VSP representative will confirm if there are no VSP doctors within the 25-mile radius.
  2. The VSP representative will transfer you to the VSP support queue for assistance with the VSP doctor access process. The VSP support queue representative will guide you through the process to receive network level reimbursement for routine vision services at an out-of-network provider.

Note: If you see an out-of-network doctor and submit a VSP request for reimbursement form without contacting VSP Member Services first, the claim will process to the out-of-network benefit for adults and deny for members under the age of 19.

To find out more information about the VSP provider network, sign in or create your account at the VSP website.

 How to create a VSP account

Visit the VSP website to view your benefits. If logging in for the first time, have your UMP member ID card handy. To create an account:
1. Enter your Member ID (do not use SSN field). You must enter all letters and numbers with no spaces. The last two digits are the numbers next to your name on your card. Example: UDWW71234567800
2. Complete all required fields.
3. Click on "Create An Account".
4. You will receive an email to finish activating your account.

 Help in scheduling an appointment

If you are a UMP member who is experiencing trouble getting an appointment scheduled with your VSP doctor, call VSP Member Services at 1 (844) 299-3041 for assistance. VSP member services can call the VSP doctor with you on the line, or on your behalf to help schedule an appointment.

 Claims and appeals

For information on how to submit a claim, or file a complaint or appeal visit Claims and appeals.

 Need help?

When you have questions about your VSP coverage or need help finding a VSP Choice network provider, contact VSP Member Services. When you have questions about diseases and disorders of the eye, contact UMP Customer Service.

The below VSP coverage table applies to adults and dependents ages 19 and over

Benefit

Frequency

Your cost with a VSP Choice network provider

Your cost with an out-of- network provider

Professional comprehensive routine eye exams

One per calendar year.

You pay $0 up to the allowed amount.

You pay 100% of billed charges.

You will be reimbursed up to $45 when you submit a claim for a covered exam.

Frames

One every two calendar years.

You pay $0 up to a $150 frame allowance; or

You pay $0 up to an $80 frame allowance for Walmart®, Sam’s Club®, or Costco® providers.

You pay 100% of billed charges.

You will be reimbursed up to $70 when you submit a claim for covered frames.

Lenses and enhancements

One set every two calendar years.

You pay $0 for the following covered lenses:

• Single vision lenses

• Lined bifocal lenses

• Standard progressive lenses

• Lined trifocal lenses

• Lenticular lenses

Note: Lens enhancement is not covered except for impact-resistant coating for dependent children ages 19 and over.

You pay 100% of billed charges.

You will be reimbursed up to the following amounts when you submit a claim for covered lenses:

• $30 single vision lenses

• $50 lined bifocal lenses

• $50 standard progressive lenses

• $65 lined trifocal lenses

• $100 lenticular lenses

Contacts

One set of contact lenses or disposable contact lenses up to the maximum allowance instead of frames and lenses every 2 calendar years.

You pay a $30 copay for contact lens evaluation and fitting exam.

You pay $0 up to a $150 contact allowance for elective contact lenses.

You pay $0 for necessary contact lenses. Note: You are still responsible for paying a $30 copay for the contact lens evaluation and fitting exam.

You pay 100% of billed charges.

You will be reimbursed up to the following amounts when you submit a claim for contact lenses:

• $105 for elective contact lenses

• $210 for necessary contact lenses

Note: Please see your plan’s UMP certificate of coverage for reimbursement rates for vision services received outside the U.S.

The below VSP coverage table applies to children under the age of 19

Benefit

Frequency

Your cost with a VSP Choice network provider

Your cost with an out-of- network provider

Professional comprehensive routine eye exams

One per calendar year.

You pay $0 up to the allowed amount.

You pay 100% of billed charges.

Frames

One per calendar year.

You pay $0 up to the allowed amount.

You pay 100% of billed charges.

Lenses and enhancements

One set per calendar year.

You pay $0 for the following covered lenses:

• Single vision lenses

• Lined bifocal lenses

• Standard progressive lenses

• Lined trifocal lenses

• Lenticular lenses

You pay $0 for the following lens enhancements:

• Scratch-resistant coating

• Ultraviolet (UV) protected lenses

• Impact-resistant coating

You pay 100% of billed charges.

Contacts

One set of contact lenses or disposable contact lenses up to the maximum allowance instead of frames and lenses every calendar year.

You pay $0 up to the allowed amount for elective or necessary contact lenses.

You pay $0 up to the allowed amount for contact lens evaluation and fitting exam.

You pay 100% of billed charges.

Note: Walmart®, Sam’s Club ®, and Costco® providers are not VSP Choice network providers for children under the age of 19 for frames, lenses, and contact lenses. Call VSP Member Services at 1 (844) 299-3041 for out-of-network plan details and vision services received outside the U.S. Deaf, DeafBlind, Late Deafened and Hard of Hearing members call 1 (800) 428-4833.

VSP is a separate company that provides vision services.