PCEA Employees Vision Summary

Provider

Summary         

HMA - Low Option Core Plan

• Pays based on a usual and set customary rate fee schedule.

• Examinations (including refractions) available once every 12 months -  paid in full

• Lenses are available once every 12 months

  • $44.50 per single lens

  • $62.50 per bifocal lens

  • $79.00 per trifocal lens

  • $50.00 per lenticular lens

• Frames are available once every 24 months

  • $40.00

• Contacts – as an alternative to lenses and frames

  • $50 per lens or $100 per calendar year

HMA - High Option Buy-up Plan

• Pays up to $250 per eligible enrollee per calendar year

• Benefits applies towards your vision examinations, corrective lenses, frames and contacts.         

Forms/Documents

Links

Summary of Vision Benefits

HMA Claim Reimbursement Form

HMA Website