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Health

State PPO

HMO

Life Insurance

Dental

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 and Materials (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 months1

12 months1

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-Network2

In-Network

Out-of-Network2

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 Lenses3

   Elective

$100 allowance

$100 allowance

$100 allowance

$100 allowance

   Medically
   Necessary4

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

1 You can purchase either glasses or contact lens. Coverage applies to one or the other.
2 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.
3 This allowance is paid with the same frequency as lenses, in the place of the lens and frame benefit.
4 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.