Vision Insurance Plan Year 2013 Optum Health Vision/Spectera

Vision InsurancePlan Year 2013

Optum Health Vision/Spectera

February 2010 2APRIL 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

February 2010 3APRIL 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

February 2010 4APRIL 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

February 2010 5APRIL 2010

Vision

Frequency:

Routine Eye Exams: every 12 months

Lenses: every 12 months

Frames: every 24 months

Contacts: every 12 months

February 2010 6APRIL 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

February 2010 7APRIL 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 2010 8APRIL 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 2010 9APRIL 2010

Benefits Chart

* Only a one time $20 material copay applies per benefit period.

February 2010 10APRIL 2010

Benefits Chart

* Only a one time $20 material copay applies per benefit period.

February 2010 11APRIL 2010

Benefits Chart

* Only a one time $20 material copay applies per benefit period.

February 2010 12APRIL 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 2010 13APRIL 2010

Benefits Chart

February 2010 14APRIL 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