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Plan name	Humana Vision PLUS
Plan type	PPO
Choice of provider	Save with our nationwide network of 170,000+ vision care access points; Save more by using a PLUS provider
Annual deductible	Does not apply
Annual benefit maximum	Unlimited
Office visits (exams)	One every 12 months from the last date of service; $10 copay with in-network provider; $0 copay with PLUS provider; $30 Allowance with out-of-network provider
Lens options	One every 12 months from the last date of service; $10 copay with in-network provider; $10 copay with PLUS provider; $25 Allowance with out-of-network provider
Contact lenses	In lieu of lenses; one every 12 months from the last date of service; $200 allowance (15% off balance over $200) with in-network provider; $200 allowance (15% off balance over $200) with PLUS provider; $92 Allowance with out-of-network provider
Waiting period	Does not apply

Note: Limitations and exclusions may apply

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“Humana” is the brand name for plans, products and services provided by one or more of the subsidiaries and affiliate companies of Humana Inc. (“Humana Entities”). Plans, products, and services are solely and only provided by one or more Humana Entities specified on the plan, product, or service contract, not Humana Inc. Not all plans, products, and services are available in each state.

Humana legal entities that offer, underwrite, administer or insure insurance products and services.

Medical Plans

Humana group medical plans are offered by Humana Medical Plan, Inc., Humana Employers Health Plan of Georgia, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Health Plan of Ohio, Inc., Humana Health Plans of Puerto Rico, Inc. License # 00235-0008, Humana Wisconsin Health Organization Insurance Corporation, or Humana Health Plan of Texas, Inc., or insured by Humana Health Insurance Company of Florida, Inc., Humana Health Plan, Inc., Humana Health Benefit Plan of Louisiana, Inc., Humana Insurance Company, Humana Insurance Company of Kentucky, Humana Insurance of Puerto Rico, Inc. License # 00187-0009, or administered by Humana Insurance Company or Humana Health Plan, Inc.

For Arizona Residents: Insured by Humana Insurance Company.

Individual Dental and Vision Plans

Humana Individual dental and vision plans are insured or offered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, The Dental Concern, Inc., CompBenefits Insurance Company, CompBenefits Company, CompBenefits Dental, Inc., Humana Employers Health Plan of Georgia, Inc. or Humana Health Benefit Plan of Louisiana, Inc. Discount plans offered by HumanaDental Insurance Company or Humana Insurance Company. For Arizona residents: Insured by Humana Insurance Company. For New Mexico residents: Insured by Humana Insurance Company. For Texas residents: Insured or offered by Humana Insurance Company, HumanaDental Insurance Company or DentiCare, Inc (d/b/a Compbenefits).

Group Dental and Vision Plans (Insurance through your employer)

Humana group dental plans are insured, offered, or administered by Humana Insurance Company, HumanaDental Insurance Company, Humana Insurance Company of New York, The Dental Concern, Inc., Humana Medical Plan of Utah, Humana Health Benefit Plan of Louisiana, Inc., CompBenefits Company, Humana Employers Health Plan of Georgia, Inc. or DentiCare, Inc. (d/b/a CompBenefits). In Arizona, group dental plans insured by Humana Insurance Company. In New Mexico, group dental plans insured by Humana Insurance Company.

Humana group vision plans are offered by Humana Insurance Company, Humana Health Benefit Plan of Louisiana, Inc., Humana Insurance Company of New York, or The Dental Concern, Inc. In Arizona, group vision plans insured by Humana Insurance Company. In New Mexico, group vision plans insured by Humana Insurance Company.

Group Life Insurance Plans (Insurance through your employer)

Humana group life plans are insured by Humana Insurance Company or Humana Insurance Company of Kentucky. In Arizona, group life plans insured by Humana Insurance Company. In New Mexico, group life plans insured by Humana Insurance Company.

Group Disability Income Insurance Plans (Insurance through your employer)

Humana group disability income plans are insured by Humana Insurance Company or Humana Insurance Company of Kentucky.

Limitations and exclusions

This communication provides a general description of certain identified insurance or non-insurance benefits provided under one or more of our health benefit plans. Our health benefit plans have exclusions and limitations and terms under which the coverage may be continued in force or discontinued. For costs and complete details of the coverage, refer to the plan document or call or write your Humana insurance agent or the company. In the event of any disagreement between this communication and the plan document, the plan document will control.

Statements in languages other than English contained in the advertisement do not necessarily reflect the exact contents of the policy written in English, because of possible linguistic differences. In the event of a dispute, the policy as written in English is considered the controlling authority.

Individual applications are subject to eligibility requirements.

Before applying for group coverage, please refer to the pre-enrollment disclosures for a description of plan provisions which may exclude, limit, reduce, modify or terminate your coverage. View plan provisions or check with your sales representative.

For group plans, please refer to your Benefit Plan Document (Certificate of Coverage/Insurance or Summary Plan Description/Administrative Services Only) for more information on the company providing your benefits.

Plans are not available in all states. Plan benefits may vary by state. Refer to the plan documents for complete details of coverage.

Dental and vision plans, excluding Dental Savings Plus, may have a minimum one-year initial contract period.

Payment may include an administration fee. Association membership and fees may be required on some plans in some states. A one-time, non-refundable enrollment fee may apply (the fee is non-refundable as allowed by state requirements). Applicable fees are disclosed at time of enrollment.

For Colorado: The Network Access Plan, which describes an access plan specific to your network, is available by calling the customer service number found on your Humana Vision ID Card/Dental ID card and requesting a copy.

This is a limited policy. This is a vision only policy.

© Humana 2024

GCHJJPDEN 07/22

Last Updated: 04/27/2023