Vision Insurance Plan Year 2012 Optum Health Vision/Spectera
February APRIL 2010 Vision Coverage level available: 4 Tier Structure I.Employee, II.Employee+Child, III.Employee+Spouse, IV.Family Pre-tax premiums Network of eye care providers Benefits available for in-network & out-of-network services
February APRIL 2010 Vision Frequency: Routine Eye Exams: every 12 months Lenses: every 12 months Frames: every 24 months Contacts: every 12 months
February APRIL 2010 Vision Insurance Vision $50 Wholesale allowance for Private Practice providers will be replaced with $130 Retail allowance – Participants will know how much they are required to spend – Participants will have more freedom of choice between Retail providers and Private Practice providers Online ID cards will be provided for Participants – Participants log in to web site: – ID cards can be printed for employee or family members – Log in with the employee’s identification number, enter the dependent’s last name and Date of Birth – No limit to the number of cards which can be printed
February APRIL 2010 Vision Select Plan Vision Insurance (Select Plan) operates the same way as the Current Plan Frequency and co-pays are the same In-network Benefits are the same Out-of-Network Reimbursements are the same
February APRIL 2010 Vision Select Plus Plan Vision Insurance (Select Plus Plan) operates the same as the Select Plan with additional enhancements: Higher maximum for contact lenses: $125 Cosmetic lens options (i.e. Tints, UV coating, Basic Progressive, Polycarbonate) are covered Glasses/frames/contacts co-pay for Select Plus Plan is $25
February APRIL 2010 Benefits Chart * Only a one time $20 material copay applies per benefit period.
February APRIL 2010 Benefits Chart * Only a one time $20 material copay applies per benefit period.
February APRIL 2010 Benefits Chart * Only a one time $20 material copay applies per benefit period.
February APRIL 2010 Medically Necessary contacts OptumHealth Vision must establish that an eligible member has any of the following: Keratoconus or irregular astigmatism Anisometropia of 3.50 diopters or more Post cataract surgery without intraocular lens Visual acuity in the better eye of less than 20/70 with spectacles, but better than 20/70 with contacts
February APRIL 2010 Benefits Chart
February APRIL 2010 Reminders If you use in-network providers, you are responsible only for your portion of cost. If you decide to use a non-network provider, you pay everything and seek the out-of-network benefits payments schedule Payment is made at the time of service To be reimbursed for an non-network service, receipts must be submitted to OptumHealth Receipts must be submitted together for services and materials purchased on different dates to receive reimbursement