
	myHealth Home 2013 Plan Year Who Is Eligible? How to Enroll Making Changes During the Year Health Plans Prescription Drugs Dental Plans Vision Plans Health Savings Account Health and Wellness Programs Reimbursement Accounts Life Insurance COBRA


Cost Estimators Contacts Forms and Publications Premium Rates FAQs

Health

State PPO

HMO

Life Insurance

Minnesota Life Insurance

Dental

Vision

Humana Vision

Supplemental

Vision

Caring for your eyes is a very important part of your overall health and wellness. That's why the state offers you competitive vision coverage at affordable rates through Humana Vision. Coverage is available to retirees through COBRA and to COBRA participants if they were enrolled prior to termination.

Plans

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

Choose Between:	Option One		Option Two
	Exam Plus (Plan 3004)		Materials Only (Plan 3006)
Monthly Member Rates
Employee Only	$5.85		$4.36
Employee + Spouse	$11.56		$8.60
Employee + Children	$11.44		$8.50
Family	$17.98		$13.38
Frequency (based on the date of service)
Exam Every	12 months		N/A
Lenses Every	12 months		12 months
Frames Every	24 months		24 months
Co-payments
Exam	$10.00		N/A
Lenses and/or Frames	$10.00		$10.00
Benefits:	In-Network	Out-of-Network	In-Network	Out-of-Network
Eye Exam	100% after co-pay	$50 allowance	N/A	N/A
Lenses
Single	100% after co-pay	$40 allowance	100% after co-pay	$40 allowance
Bifocal	100% after co-pay	$60 allowance	100% after co-pay	$60 allowance
Trifocal	100% after co-pay	$80 allowance	100% after co-pay	$80 allowance
Frames	$75 wholsale	$60 retail	$75 wholsale	$60 retail
Contact Lenses **
Elective	$100 allowance	$100 allowance	$100 allowance	$100 allowance
Medically Necessary+	100%	$200 allowance	100%	$200 allowance
Lasik	Members receive a 10% discount off usual, customary, and reasonable charges at preferred LASIK provider locations and pay no more than $1,800 per eye for the Conventional LASIK procedure and $2,300 per eye for Custom LASIK. Members receive benefits where TLC Truvision network providers are available, with the following preferred rates: 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)
Calendar Year Deductible	None, after plan co-payments
Calendar Year Maximum Benefit	Up to plan limits
Lifetime Maximum Benefit	Unlimited
Waiting Periods	None
* The amounts shown are maximum benefits. The actual benefit amount the plan will reimburse to a plan member for non-network doctors will be the least of the maximum shown in the schedule, the amount actually charged, or the amount a doctor usually charges a private patient. ** This allowance is paid with the same frequency as lenses, in the place of the lens and frame benefit. + Medically necessary (prior authorization required) is defined as 1) following cataract surgery without intraocular lens, 2) correction of extreme visual acuity problems not correctable with glasses, 3) anisometropia greater than 5.00 diopters and asthenopia or diplopia, with spectacles, 4) Keratoconus, or 5) monocular aphakia and/or binocular aphakia where the doctor certifies contact lenses are medically necessary for safety and rehabilitation to a productive life.

For more detail, visit the Humana Vision Web site.