Humana Exam & Materials UFSelect Humana (state) 3004 …
[Pages:1]Pre-tax
Humana Exam & Materials (state) 3004
Yes
Waiting Periods
None
Frequency (based on the date of service)
Exam Every
12 months
Lenses Every
12 months
Frames Every
24 months
Co-payments (You pay)
Exam
$10.00
Lenses and/or Frames
$10.00
Benefits (Plan pays)
In-network
Non-Network
Eye Exam
100% after copay
$40 allowance
UFSelect Humana Exam & Materials
No
None
12 months 12 months 24 months
$10.00 $15.00
In-Network 100% after co-pay
Non-Network $30 allowance
Single
100% after copay
$40 allowance
100% after co-pay
Bifocal
100% after copay
$60 allowance
100% after co-pay
Trifocal
100% after copay
$80 allowance
100% after co-pay
Frames
$75 wholesale
$60 retail allowance
$150 retail allowance
Contact Lenses (can be substituted for lenses; coverage can be applied to one or the other)
$25 allowance $40 allowance $60 allowance $65 retail allowance
Elective
$150 allowance $75 allowance
$150 allowance
$104 allowance
Medically Necessary (requires prior authorization) LASIK
Coverage for domestic partners & partner's dep.
100%
$100 allowance 100%
$200 allowance
Humana has contracted with many well-known facilities and eye doctors to offer LASIK procedures at substantially reduced fees. You can take advantage of these low fees when procedures are done by network providers.
No
Yes
University of Florida ? Office of Human Resource Services ? Benefits 352.392.2477 ? 903 West University Avenue ? Gainesville, Florida 32601
Revised 09/16/19
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- department of administrative services human resources
- the following are employee pay all university of florida
- humana exam materials ufselect humana state 3004
- regulations of the university of florida
- necp ay 202 application
- bsn program prerequisite courses university
- personal liability and human resource decision making
- plan type of benefit offered through
- cuhre apac conference contact listing florida a m
- instructions for completing the hr 600 form
Related searches
- ny state physical exam form
- ela state exam grade 6
- 3rd grade state exam practice
- state exam for third graders
- new york state civil service exam results
- nevada exam state board of cosmetologists
- 8th grade state exam ela
- new york state exam results
- california state bar exam requirements
- cosmetology state exam practice test
- new york state exam announcements
- cosmetology state board exam practice test