Benefits 2020 Vision & Hearing Plans

2020

Vision & Hearing Plans

Vision Service Plan - Annual Eye Exam

Eye Examination

100% once every 12 months

Diabetic Eyecare Plus

100% after $20 Copay

Vision Service Plan - Eye Hardware

Visit the 24/7 Retail Eyewear Solution for VSP Members: www.eyeconic.com
Frames	Once every 24 months. 100% after $15 Copay. Frames covered up to $175 ($95 allowance at Costco)
Lenses	Once every 12 months. Single vision, lined bifocal, lined trifocal lenses, UV ray protection, scratch-resistance coating, anti-reflective coating, and rimless mounting covered; Polycarbonate lenses for dependent children.
Contact Lenses	Once every 12 months, 100% to a max of $155.
Contact Lens exam	Paid in full after a copay of up to $60.
Benefit Limitations	Members may choose between the benefit of glasses or contact lenses, but not both, during any benefit plan period.

Medical Insurance - Annual Eye Exam

Contact your plan about cost for children's vision care.
Kaiser Permanente WA Classic	$15
Kaiser Permanente WA Value	$30
Kaiser Permanente WA Sound Choice	0%
Kaiser Permanente WA CDHP	10%
Uniform Medical Plan Classic	$0 You pay any amount over $65 for contact Lens fitting fees.
UMP Plus - Puget Sound High Value Network
UMP Plus - UW Medicine Accountable Care Network
Uniform Medical CDHP
Kaiser Permanente NW Classic	$25
Kaiser Permanente NW CDHP	$20

Medical Insurance - Eye Hardware

Kaiser Permanente WA Classic	You pay any amount over $150 every 24 months for frames, lenses, and contacts combined.
Kaiser Permanente WA Value
Kaiser Permanente WA SoundChoice
Kaiser Permanente WA CDHP
Uniform Medical Plan Classic	You pay any amount over $150 every two calendar years for frames, lenses, and contacts combined.
UMP Plus - Puget Sound High Value Network
UMP Plus -UW Medicine Accountable Care Network
Uniform Medical CDHP
Kaiser Permanente NW Classic	You pay any amount over $150 every 24 moths for frames, lenses, and contacts combined.
Kaiser Permanente NW CDHP

Hearing - Annual Exam

Kaiser Permanente WA Classic	Primary Care $15 Specialist $30
Kaiser Permanente WA Value	Primary Care $30 Specialist $50
Kaiser Permanente WA SoundChoice	Primary Care $0 Specialist $30
Kaiser Permanente WA CDHP	10%
Uniform Medical Plan Classic	$0
UMP Plus - Puget Sound High Value Network	$0
UMP Plus -UW Medicine Accountable Care Network	$0
Uniform Medical CDHP	15%
Kaiser Permanente NW Classic	$35
Kaiser Permanente NW CDHP	$30

Hearing Hardware

TruHearing Hearing Aid Discount Program Offered in partnership with Vision Service Plan. TruHearing Customer Service (877) 396-7194 or www.truhearing.com TruHearing Summary of Benefits
Kaiser Permanente WA Classic	You pay any amount over $800 every 36 months for hearing aid and rental/repair combined.
Kaiser Permanente WA Value
Kaiser Permanente WA SoundChoice
Kaiser Permanente WA CDHP
Uniform Medical Plan Classic	You pay any amount over $800 every three calendar years for hearing aid and rental/repair combined. (CDHP is subject to deductible)
UMP Plus - Puget Sound High Value Network
UMP Plus -UW Medicine Accountable Care Network
Uniform Medical CDHP
Kaiser Permanente NW Classic	You pay any amount over $800 every 36 months for hearing aid and rental/repair combined.
Kaiser Permanente NW CDHP	You pay any amount over $800 every 36 months after deductible has been met for hearing aid and rental/repair combined.