Vision Insurance
EMPLOYEE BENEFITS
Humana ABOUT VISION Vision insurance provides coverage for routine eye examinations and can help with covering some of the costs for eyeglass frames, lenses or contact lenses.
For full plan details, please visit your benefit website: www.mybenefitshub.com/galvestonisd
Vision Employee Only
$8.92
Employee and Spouse Employee and Child(ren) Employee and Family
$17.86 $18.46 $28.12
Vision care services Exam with dilation as necessary 1 • Retinal imaging Contact lens exam options 2 • Standard contact lens fit and follow-up • Premium contact lens fit and follow-up Frames 3 Standard plastic lenses 4 • Single vision • Bifocal • Trifocal • Lenticular Covered lens options 4 • UV coating • Tint (solid and gradient) • Standard scratch-resistance • Standard polycarbonate - adults • Standard polycarbonate - children <19 • Standard anti-reflective coating • Premium anti-reflective coating – Tier 1 – Tier 2 – Tier 3 • Standard progressive (add-on to bifocal)
If you use an IN-NETWORK provider (Member cost) $10 Up to $39
If you use an OUT-OF-NETWORK provider (Reimbursement) Up to $30 Not covered
$0 10% off retail less $55 allowance $160 allowance 20% off balance over $160
Up to $30 Up to $30 $80 allowance
$10 $10 $10 $10
Up to $25 Up to $40 Up to $60 Up to $100
$15 Not covered $15 Not covered $15 Not covered $40 Not covered $0 Not covered $10 Up to $25 Premium anti-reflective coatings as follows: Premium anti-reflective coatings as follows: $22 Up to $25 $33 Up to $25 80% of charge less $35 allowance Up to $25 $10 Up to $40
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