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Published byChad Elwin Cummings Modified over 9 years ago
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Vision Insurance Plan Year 2013 Optum Health Vision/Spectera
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February 2010 2 APRIL 2010 Vision – Spectera Branding name will change from OptumHealth to Spectera Select Plus Plan will have the following enhancements: – Frequency of frames will change to once every 12 months – Frame allowance of $150 is provided for private practice or retail chain providers – Standard contact lenses will have a $200 allowance – Allow up to 8 boxes of standard, disposable lenses Out-of-network allowance for contact lenses will increase to $200 under the Select Plus Plan Plan Design/Premium Changes for AE 2013
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February 2010 3 APRIL 2010 Vision – Spectera New premium rate structure for the Select Plus Plan – You Only $8.62 – You + Spouse $18.61 – You + Child $19.45 – You + Family $26.35 Plan Design/Premium Changes for AE 2013 Admin fee is included in amount
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February 2010 4 APRIL 2010 Vision Coverage level available: 4 Tier Structure Employee, Employee+Child, Employee+Spouse, Family Pre-tax premiums Network of eye care providers Benefits available for in-network & out-of-network services
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February 2010 5 APRIL 2010 Vision Frequency: Routine Eye Exams: every 12 months Lenses: every 12 months Frames: every 24 months Contacts: every 12 months
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February 2010 6 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: www.myoptumhealthvision.com – 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
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February 2010 7 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
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February 2010 8 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
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February 2010 9 APRIL 2010 Benefits Chart * Only a one time $20 material copay applies per benefit period.
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February 2010 10 APRIL 2010 Benefits Chart * Only a one time $20 material copay applies per benefit period.
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February 2010 11 APRIL 2010 Benefits Chart * Only a one time $20 material copay applies per benefit period.
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February 2010 12 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
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February 2010 13 APRIL 2010 Benefits Chart
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February 2010 14 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
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