Note: Spectera Vision has changed its name to
OptumHealth Vision

The OptumHealth Vision Plan provides partial payment to help you offset the costs of annual eye exams (which are also covered under Uniform Benefits), frames, lenses and contact lenses. It also provides discounted refractive eye surgery at select locations.

Eligibility

You must be eligible for immediate or future employer contribution to the State of Wisconsin Health Insurance Program to participate. Unclassified faculty, academic staff and short-term academic staff appointees, classified employees (including LTE's covered by the retirement system), graduate assistants, fellows and scholars and employees in-training are eligible to enroll in this vision plan.

Eligible dependents of these employees may enroll as dependents of the employee. Domestic partners and their children are eligible under this plan.

Rehired annuitants receiving a Wisconsin Retirement System benefit are not eligible for this program.

WRS annuitants who are not covered under OptumHealth at the time of retirement may enroll during the open enrollment period by applying through the Department of Employee Trust Funds. Non-covered annuitants can click here for additional information.

Enrollment

The initial enrollment period for new employees is 30 days from the employment begin date. Coverage will begin on the first of the month on or after your campus benefits office receives your completed application.

If you do not enroll during your intial enrollment deadline, you may enroll during an open enrollment period. Open enrollment periods are offered annually to coincide with the Dual-Choice health insurance enrollment period.

You can print an application here.

Coverage  

If you use a OptumHealth vision provider, this plan will cover:

• One vision exam per 12-month period with a $10 copayment.
• After a $25 copayment:
  • One pair of frames per 24-month period.
  • One pair of eyeglass lenses per 12-month period (you only pay one $25 copayment if you purchase frames and lenses together).
  • Contact lenses (including up to four boxes of disposable contact lenses). Contacts and frames cannot be purchased in the same 12-month period.

If you or your covered family members use a OptumHealth vision provider, simply provide the member's name and birth date and the employee's social security number (alternate ID numbers may be requested).

You may also see a non-OptumHealth vision provider but you will likely experience higher out of pocket costs. You will also have to pay the charges at the time of service and file a claim with OptumHealth to receive reimbursement.

To locate a OptumHealth provider near you, you can call OptumHealth 's IVR line at 1-800-638-3120 or you can log on to http://www.myoptumhealthvision.com and click on Members and Future Members and enter your zip code.

For more information, review the Summary & Reference Guide and the Commonly Asked Questions. Please also review the Patient Options to see the cost of additional features for your glasses or contacts.

Important Note: If you enroll in OptumHealth Vision Insurance, you must remain in the plan for the remainder of the calendar year. To cancel coverage, you must submit an application to cancel coverage before December 1st. Coverage will end on December 31. Mid-year cancellation is only possible due to termination of employment or death.

Premiums  

The monthly premiums for the OptumHealth Vision Plan are:

Employee Only:	$ 5.83
Employee + Spouse:	$11.34
Employee + Child(ren):	$11.88
Employee + Family:	$17.82

Premiums are deducted on pre-tax basis. At this time, due to IRS regulations, the premium for LTEs and employees who enroll with a domestic partner cannot be taken pre-tax.

Premiums are paid one month in advance of the coverage month. For classified, the premiums will be deducted from the A payroll.

This document was last revised on November 19, 2008