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For Services incurred prior to January 1, 2011 the vision plan Third party Administrator is HMA.
For Services effective January 1, 2011 the PPO vision plan TPA has changed to UMR.
Effective April 1, 2011 IAFF Kaiser Medical members have a Kaiser $500 vision plan. See the Kaiser Summary of Benefits for details. |
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Plan |
Summary |
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UMR PPO Vision $500 plan
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The $500 Vision Plan per 2 calendar year period pays for vision examinations, corrective lenses, frames or contacts when prescribed by an ophalmologist or optometrist. As per Healthcare Reform, children age 0-18 have 100% routine vision exam coverage if services are with a preferred provider and the $500 benefit will apply for hardware. Members age 19 and above have the $500 combination vision plan.
Age 0-18
- Exams (including refraction)-Once every 12 months.
- Participating provider 100%,
- Non-participating provider 60%.
- Hardware-any combination of corrective lenses, frames and contact lenses up to maximum $500 every 2 calendar years per enrolled person.
Age 19 and above
$500 maximum every 2 calendar years per enrolled person for any combination of routine vision exams, corrective lenses, frames and contact lenses.
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| UMR PPO Vision Traditional Plan |
Pays based on a usual and set customary rate fee schedule.
Examinations (including refractions) available once every 12 months -
- Participating provider 100%
- Non-participating provider $25.00 maximum benefit
Lenses are available once every 12 months
- $89.00 single lenses
- $125.00 bifocal lenses
- $158.00 trifocal lenses
- $50.00 lenticular lenses
Frames are available once every 24 months- $40.00
Contact lenses - maximum $100 per calendar year |
| Effective February 1, 2011 new IAFF employees are only offered the $500 vision plan. The Traditional vision plan is Grandfathered for existing plan members, but is not available as an option at Open Enrollment. |
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Kaiser Vision
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Effective April 1, 2011 IAFF members with Kaiser medical have a Kaiser vision plan. Services must be performed at Kaiser Clinic as per Kaiser Permanente guidelines.
- Routine Exams, $15 co-pay
- Prescription lenses, frames and contact lenses up to $500 maximum one time claim every 24 months per enrolled person
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Forms/Documents
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Links
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All forms related to this plan can be found in the benefits Forms Library. Click Here to go to the Forms Library.
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www.umr.com
www.umr.com/oss/cms/umr/Options_PPO_Exclusions.html Preferred Provider search
UMR Customer Service (866) 868-7758
www.kaiserpermanente.org
Kaiser Customer Service 800-813-2000 | |