2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Complete (PPO) Chapter 4: Medical Benefits Chart (what is covered and what you pay) 126 Services that are covered for you What you must pay when you get these services in-network and out-of-network device, like a tablet or smart phone. These doctors are providers that have the ability to offer virtual doctor visits. During a virtual visit, you can ask questions, get a diagnosis and the doctor may be able to prescribe medication that, if appropriate, can be sent to your pharmacy. Doctors can’t prescribe medications in all states. You can find a list of participating virtual doctors online at retiree.uhc.com/ wapebb. Vision services Covered services include: · Outpatient physician services provided by an $0 copayment for each ophthalmologist or optometrist for the diagnosis and Medicare-covered exam.†† treatment of diseases and injuries of the eye, including diagnosis or treatment for age-related macular degeneration or cataracts. Original Medicare doesn’t cover routine eye exams (eye refractions) for eyeglasses/contacts. · For people who are at high risk of glaucoma, we will $0 copayment for Medicare- cover one glaucoma screening each year. People at covered glaucoma screening. high risk of glaucoma include: people with a family history of glaucoma, people with diabetes, African Americans who are age 50 and older, and Hispanic Americans who are 65 or older. · For people with diabetes or signs and symptoms of eye $0 copayment for each disease, eye exams to evaluate for eye disease are Medicare-covered diabetic eye †† covered per Medicare guidelines. Annual examinations exam. by an ophthalmologist or optometrist are recommended for asymptomatic diabetics.