Vision


For Services incurred prior to January 1, 2011 the vision plan Third Party Administrator is HMA. For Services effective January 1, 2011 the vision plan TPA has changed to UMR. Effective January 1, 2011 Unrepresented Kaiser Medical members have a Kaiser $250 vision plan. See the Kaiser Summary of Benefits for details.

Plan

Summary

UMR PPO

Traditional Plan (Core)

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

UMR PPO

$250 Vision plan (Buy-up)

The $250 Vision plan pays for routine vision examinations, corrective lenses, frames and 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 $250 benefit will apply for hardware. Members age 19 and above have the $250 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 $250 every calendar year per enrolled person.

Age 19 and above

$250 maximum every calendar year per enrolled person for any combination of routine exams, corrective lenses, frames and contact lenses.

Effective 01/01/2011, new employees are only offered the $250 vision plan. The Traditional vision plan is Grandfathered for existing plan members, but is not available as an option at Open Enrollment.

Kaiser Vision

Effective January 1, 2011 Unrepresented members with Kaiser medical have a Kaiser vision plan. Services must be performed at Kaiser Clinic as per Kaiser Permanente guidelines.

Routine vision exams-$15 co-pay
Prescription lenses, frames and contact lenses up to $250 maximum every 12 months per enrolled person.

Forms/Documents

Links

All forms related to this plan can be found in the benefits Forms Library. Click Here to go to the Forms Library.

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