Page, Scrantom - Staffs Benefit Guide

Vision Coverage

The vision plan covers routine eye exams and also pays for all or a portion of the cost of glasses or contact lenses if you need them.

Your PPO vision plan is through Humana and offers “in and out-of-network” benefits.

To find an in-network provider, visit www.humana.com/vision-insurance/find-an-eye-doctor

Insurance Carrier:

Humana Vision Insurance Humana Vision Exam Plus

Plan Type:

In-Network $10 Copay $50 Copay $70 Copay $105 Copay

Out-of-Network $30 allowance

Exam Services

Lenses - Single lined Lenses - Bifocal lined

Not covered Not covered Not covered

Lenses - Trifocal

Contacts / Lenses

15% off retail

Not covered

Frames

Not covered

Not covered

Frequency for Exam / Lenses / Frames

Exam - 12 months Lenses & Frames - Not covered

Employee Bi-Weekly Deduction Employee Only

$1.32 $2.65 $2.52 $3.95

Employee + Spouse Employee + Child(ren)

Family

7 Page, Scrantom 2022 Enrollment Guide

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