Humana Vision VCP Network

Transcription

1 Generic Humana Vision VCP Network Humana.com GN51511HV 1214

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3 Feel good about choosing a Humana vision plan A vision plan is one of the top five most desired benefits, after medical insurance, by employees 1 1 LIMRA International 2 Humana vision member satisfaction survey, 2008 Thank you for considering a Humana vision plan. It s important your employees keep their eyes healthy and get routine care. A comprehensive eye health exam can help prevent vision loss, and also detect more serious diseases such as diabetes, hypertension, multiple sclerosis, and brain tumors. You can feel good knowing Humana vision plans encourage prevention, early diagnosis, and treatment. Feel even better knowing: More than 35,000 participating optometrist, ophthalmologist, and national retail locations and all accept new patients. Employees build relationships with providers who know their health and family histories so they can detect conditions such as diabetes and hypertension. Employees receive a wholesale frame allowance they never pay full retail. Employees may receive savings on lenses, lens options, contact lenses and Lasik procedures. You can offer a voluntary Humana vision plan without increasing your benefits budget. You and your employees can expect friendly, personal service. In fact, nine out of 10 calls are resolved to the customer s satisfaction on the first call. 2

4 Vision health impacts overall health Eye health exams are an important part of routine preventive healthcare. Because many eye and vision conditions have no obvious symptoms, your employees may be unaware of problems. Early diagnosis and treatment are important for maintaining good vision and preventing permanent vision loss. 1 Vision care is essential to maintaining a healthy lifestyle. Eye exams can detect symptoms of diseases such as diabetes, hypertension, multiple sclerosis, brain tumors, osteoporosis, and rheumatoid arthritis. 2 According to the Vision Council of America, vision problems affect 120 million Americans and cost businesses an estimated $8 billion annually because of reduced productivity. National network provides real savings Employees have access to one of the largest vision networks in the United States, with more than 35,000 participating provider locations. They ll be able to use their benefits at some of the top names in eye care, including LensCrafters, Pearle Vision, Sears Optical, Target Optical, and JCPenney Optical in addition to the many independent optometrists and ophthalmologists. Plus, your employees save on eyewear. Their out of pocket cost is based on wholesale pricing for frames, avoiding high retail markups, and may benefit with fixed pricing for most lens options including anti-reflective and scratchresistant coatings. What does this mean to your employees? With fixed pricing, employees may pay the same price for eyewear at any provider location. Personalize your Humana vision plan You ll work with your broker and our own vision expert to design a plan that best fits you and your employees needs. You can: Choose voluntary or employer-sponsored plans Talk directly with a Customer Care specialist and/or manage your plan online at HumanaVisionCare.com Use the enrollment option that works best for you: Web, list enrollment, or paper 1 American Optometric Association 2 Thompson Media, Inc. Affordable frames Benefits include a wholesale frame allowance. If the wholesale cost exceeds the frame allowance, employees pay twice the wholesale difference. They never pay full retail. Retail price * Wholesale price Wholesale allowance Member pays Savings $125 $50 $50 $0 $125 $ $75 $50 $50 ($75-$50=$25x2=$50) $ * Retail costs may differ and are based on 2½ times the wholesale cost. Actual savings may vary. JCPenney Optical

5 Humana Vision Care Plan Exam Plus 4, 6 See a participating provider See a nonparticipating provider See a participating provider Exam with dilation as necessary 100% after copay $35 allowance $10 copay Lenses Single vision Bifocal Trifocal Lenticular 100% after copay 100% after copay 100% after copay 100% after copay $25 allowance $40 allowance $60 allowance $100 allowance Members may receive additional fixed copayments on lens options including anti-reflective and scratch-resistant coatings. After copay, standard poly carbonate available at no charge for dependents less than 19 years old. 20% retail discount Frames Wholesale frame allowance $40 retail allowance 20% retail discount Contact lenses 1 Elective (conventional and disposable) 2 Medically necessary Contact lens allowance 100% Contact lens allowance $210 allowance 15% discount on professional services (evaluation and fitting fee) 5 Frequency (based on date of service) Examination Lenses or contact lenses Frame Copay and allowance options Once every 24 months Exam/material copay options 3 o $10/$15 o $15/$15 o $15/$20 o $20/$20 Wholesale frame allowance options Approximate retail value: o $40 o $80/$120 o $45 o $90/$135 o $50 o $100/$150 Once every 24 months Not available Not available Elective contact lens allowance o $110 o $150 o $110 o $150 To locate a participating provider, visit HumanaVisionCare.com. Other discounts By using a participating provider, members may be eligible to receive up to a 20 percent retail discount on a second pair of eyeglasses, which is available for 12 months after the covered eye exam through the participating provider who sold the initial pair of eyeglasses. Visit HumanaVisionCare.com to find a participating provider. 1 If a member prefers contact lenses, the plan provides an allowance for contacts in lieu of all other benefits (including frames) (Vision Care Plan only). 2 Members visiting a participating provider may be eligible to receive up to a 15 percent discount. Applies to professional services (evaluation and fitting fee). 3 Material copay is required for a complete pair of eyeglasses, lenses or frames. 4 With the Exam Plus vision plan members may receive the discounts listed by using certain participating providers. 5 Exam Plus discount does not apply to contact lens materials. 6 Exam Plus is not available in Connecticut or Massachusetts. Humana Vision Lasik We have contracted with many well-known facilities and eye doctors to offer Lasik procedures at substantially reduced fees. Your employees can take advantage of these low fees when procedures are done by network providers. The network locations listed below offer the following prices (per eye): TLC (designated locations only) LasikPlus QualSight LASIK Conventional/Traditional** Custom** $895 $1,295 $1,895* $695* $1,395* LasikPlus free LasikPlus free enhancements enhancements for 1 year for life $895 $1,295 QualSight free with QualSight enhancements Lifetime for 1 year Assurance Plan $1,895* LasikPlus free enhancements for life $1,320 $1,995* with QualSight Lifetime Assurance Plan You may receive a 10% discount from retail prices at certain independent Lasik participating providers and pay no more than $1,800 per eye for Conventional Lasik and $2,300 per eye for Custom Lasik. *with IntraLase TM ** Pricing varies by section procedure offered by the provider you choose and options in your area. Not all locations offer fixed pricing. Please call the provider for details.

6 Using HumanaVisionCare.com, you can: Find a network provider View benefits Check eligibility Plus, your employees can quickly find network providers and check the status of claims. Humana vision plan guidelines Eligibility Employer contribution Participation Employer-sponsored at least 50% 5 or more enrolled* Voluntary less than 50% 5 or more enrolled* * 2 4 considered if sold with Humana medical or dental insurance plans with a minimum of 25% participation and no fewer than 2 enrolled. All case sizes not available in all markets. Limitations In no event will coverage exceed the lesser of: 1. The actual cost of covered services or materials 2. The limits of the policy, shown in the Schedule of Benefits, or 3. The allowance as shown in the Schedule of Benefits Materials covered by the policy that are lost or broken will only be replaced at normal intervals as provided for in the Schedule of Benefits. We will pay only for the basic cost for lenses and frames covered by the policy. The insured is responsible for extras selected, including but not limited to: 1. Blended lenses 2. Progressive multifocal lenses 3. Photochromic lenses; tinted lenses, sunglasses, prescription and plano 4. Coating of lens or lenses 5. Laminating of lens or lenses 6. Groove, drill or notch, and roll and polish; unless otherwise specifically listed as a covered benefit in the Schedule of Benefits Exclusions We won t cover: 1. Orthopic or vision training and any associated supplemental testing 2. Two pair of glasses, in lieu of bifocals, trifocals or progressives 3. Medical or surgical treatment of the eyes 4. Any services and/or materials required by an employer as a condition of employment 5. Any injury or illness covered under any workers compensation or similar law 6. Sub-normal vision aids, aniseikonic lenses or non-prescription lenses 7. Charges incurred after: (a) the policy ends or (b) the insured s coverage under the policy ends, except as stated in the policy 8. Experimental or nonconventional treatment or device 9. Contact lenses, except as specifically covered by the policy 10. Hi index, aspheric and non-aspheric styles 11. Oversized 61 and above lens or lenses 12. Cosmetic items, unless otherwise specifically listed as a covered benefit in the Schedule of Benefits

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8 Insured by Humana Insurance Company, CompBenefits Insurance Company, Humana Dental Insurance Company, CompBenefits Company, or The Dental Concern, Inc. This is not a complete disclosure of the plan qualifications and limitations. Specific limitations and exclusions as contained in the Regulatory and Technical Information Guide will be provided by the agent/broker. Please review this information before applying for coverage. The amount of benefits provided depends on the plan selected. Premiums will vary according to the plan selection. GN51511HV 1214 Policy number: VGRP-CERT.002