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2015‐2016 Benefits Guide
Vision Insurance
Humana will be your vision carrier for 2015 / 2016 plan year.
Employees are eligible for vision insurance the first of the
month after thirty (30) days of employment for regular full-
time employees. Dependent children are eligible until the
end of the month in which they turn age 26.
Humana Vision Plan Summary
Benefits/Service
In-Network
Out-of-Network
Examination Copay
$10 Copay
$35 Allowance
Frequency of Service:
Exam
Lenses
Frames
Every 12 Months
Every 12 Months
Every 24 Months
Frame
$50 Wholesale
Allowance
$40 Retail
Allowance
Lenses:
Single
Bifocal
Trifocal
$15 Copay
$15 Copay
$15 Copay
Allowance
$25
$40
$60
Contact Lenses:
Necessary
Elective
Paid in Full
$150 Allowance
$210 Allowance
$150 Allowance
Type of Coverage
Employee Cost
Employee
$4.15
Employee & Spouse
$8.30
Employee & Child(ren)
$7.88
Employee & Family
$12.39
Humana Vision
Per Paycheck Employee Cost