Embed Size (px)
DESCRIPTION
Vision Insurance Plan Year 2013 Optum Health Vision/Spectera. Plan Design/Premium Changes for AE 2013. 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 - PowerPoint PPT Presentation
Citation preview
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
