1 / 14

Vision Insurance Plan Year 2013 Optum Health Vision/Spectera

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

Download Presentation

Vision Insurance Plan Year 2013 Optum Health Vision/Spectera

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Vision InsurancePlan Year 2013Optum Health Vision/Spectera

  2. 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 • 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

  3. Plan Design/Premium Changes for AE 2013 • 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 Admin fee is included in amount

  4. 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

  5. Vision • Frequency: • Routine Eye Exams: every 12 months • Lenses: every 12 months • Frames: every 24 months • Contacts: every 12 months

  6. 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

  7. 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

  8. 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

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

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

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

  12. 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

  13. Benefits Chart

  14. 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

More Related