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Vision

Vision coverage is only available to retirees eligible for COBRA and COBRA participants.

Caring for your eyes is a very important part of your overall health and wellness. That's why the state offers competitive vision coverage at affordable rates through COBRA to retirees and COBRA participants.

New Vision Care Plans

In 2009, the state will partner with Humana Vision to offer vision coverage. When you enroll, you can tap into an extensive national network of vision care providers once every 12 months for exams and lenses, and once every 24 months for frames. You can also use out-of-network vision care providers and submit a claim to receive benefits up to a set allowance based on the type of service.

You have two vision plans to choose between:

Option 1 covers exams, frames and lenses
Option 2 covers only frames and lenses

Vision Plan Highlights

Covered Services	In-Network	Out-of-Network*
Comprehensive Exam … once every 12 months (Option 1 – Exam Plus plan only)	Plan pays 100% after your $10 copay	Plan pays up to $50 allowance
Lenses … once every 12 months	Plan pays 100% after your $10 copay for standard single vision, lined bifocal trifocal or lenticular lenses	Plan pays up to: $40 for single vision $60 for bifocal $80 for trifocal and lenticular
Frames … once every 24 months	Plan pays 100% after your $10 copay, up to a $75 wholesale allowance	Plan pays up to $60
Contact Lenses (in lieu of eyeglasses) … once every 12 months	Plan pays: Medically necessary:** 100% after your $10 copay Elective: $100 toward fitting, follow-up and lenses	Plan pays up to: Medically necessary:** $200 Elective: $100
LASIK	10% discount off UCR charges at preferred LASIK provider locations, and pay no more than: $1,800 per eye for Conventional LASIK procedure $2,300 per eye for Custom LASIK. Where TLC Truvision network providers are available, the following preferred rates apply: Silver package: $895/eye for Conventional LASIK Gold package: $1,295/eye for Custom LASIK Platinum package: $1,895/eye for Custom LASIK plus Bladeless LASIK (using Intralase technology)

*The actual benefit amount the plan will reimburse for non-network doctors will be the least of the maximum shown in the chart, the amount actually charged, or the amount a doctor usually charges a private patient.

** Medically necessary (prior authorization required) is defined as 1) following cataract surgery without intraocular lens, 2) correction of exreme visual acuity problems not correctable with glasses, 3) anisometropia greater than 5.00 diopters and asthenopia or diplopia, with spectacles, 4) Keratoconus, or 5) moncular aphakia and/or binocular aphakia and/or binocular aphakia where the doctor certifies contact lenses are medically necessary for safety and rehabiliation to a productive life.

For more detail, visit the Humana Vision Web site.

2009 Vision Premium Rates

Coverage Level	Option 1: Exam Plus (PF #3004)	Option 2: Materials Only (PF#3006)
Employee	$5.85	$4.36
Employee + Spouse	$11.56	$8.60
Employee + Children	$11.44	$8.50
Employee + Family	$17.98	$13.38