Client Business LLC: Coverage Summaries

Client- HUMANA Vision Monthly - HOURLY Per. Pay

Effective December 1, 2016
VOLUNTARY Group Vision Plan: HUMANA VISION 200
Product Type:Voluntary Enrollment
Deductible:None
Frequency:
Exam12 months
Lenses12 months
Frames24 months
In-Network Co-Pays:
Exam$0
Materials - Covered Frames$200 Allowance
Materials - Retail Frames20% Discount
Materials - Standard Lenses$0
Additional OptionsDiscounts
Contact Lenses - In lieu of Eyeglasses:
Exam (Evaluation and Fitting)$0
Exam (Current Wearers)$0
Materials - Covered Lenses$200 Allowance
Materials - Retail Lenses15% Discount
Medically NecessaryCovered in Full w/ pre-approval
Out-of-Network Allowance:
ExamUp to $30
Materials - FramesUp to $100
Materials - Single Vision LensesUp to $25
Materials - Bifocal LensesUp to $40
Materials - Trifocal LensesUp to $60
Materials - Contact LensesUp to $160
Medically NecessaryUp to $210
PER PAYCHECK DEDUCTIONS
Employee:$4.38
Employee with Spouse:$8.76
Employee with Child(ren):$8.32
Employee with Family:$13.07
SPREADSHEET FOR ILLUSTRATIVE PURPOSES ONLY
PLEASE REFER TO INSURANCE CARRIER SUMMARY FOR DETAILS OF BENEFITS PROVIDED
BENEFITS ARE PAYABLE ACCORDING TO THE VISION INSURANCE CARRIER CERTIFICATE OF BENEFITS

Client- HUMANA Vision Monthly - HOURLY Per. Pay

Effective December 1, 2016
VOLUNTARY Group Vision Plan: HUMANA VISION 200
Product Type:Voluntary Enrollment
Deductible:None
Frequency:
Exam12 months
Lenses12 months
Frames24 months
In-Network Co-Pays:
Exam$0
Materials - Covered Frames$200 Allowance
Materials - Retail Frames20% Discount
Materials - Standard Lenses$0
Additional OptionsDiscounts
Contact Lenses - In lieu of Eyeglasses:
Exam (Evaluation and Fitting)$0
Exam (Current Wearers)$0
Materials - Covered Lenses$200 Allowance
Materials - Retail Lenses15% Discount
Medically NecessaryCovered in Full w/ pre-approval
Out-of-Network Allowance:
ExamUp to $30
Materials - FramesUp to $100
Materials - Single Vision LensesUp to $25
Materials - Bifocal LensesUp to $40
Materials - Trifocal LensesUp to $60
Materials - Contact LensesUp to $160
Medically NecessaryUp to $210
PER PAYCHECK DEDUCTIONS
Employee:$4.38
Employee with Spouse:$8.76
Employee with Child(ren):$8.32
Employee with Family:$13.07
SPREADSHEET FOR ILLUSTRATIVE PURPOSES ONLY
PLEASE REFER TO INSURANCE CARRIER SUMMARY FOR DETAILS OF BENEFITS PROVIDED
BENEFITS ARE PAYABLE ACCORDING TO THE VISION INSURANCE CARRIER CERTIFICATE OF BENEFITS

Client- HUMANA Vision Monthly - HOURLY Per. Pay

Effective December 1, 2016
VOLUNTARY Group Vision Plan: HUMANA VISION 200
Product Type:Voluntary Enrollment
Deductible:None
Frequency:
Exam12 months
Lenses12 months
Frames24 months
In-Network Co-Pays:
Exam$0
Materials - Covered Frames$200 Allowance
Materials - Retail Frames20% Discount
Materials - Standard Lenses$0
Additional OptionsDiscounts
Contact Lenses - In lieu of Eyeglasses:
Exam (Evaluation and Fitting)$0
Exam (Current Wearers)$0
Materials - Covered Lenses$200 Allowance
Materials - Retail Lenses15% Discount
Medically NecessaryCovered in Full w/ pre-approval
Out-of-Network Allowance:
ExamUp to $30
Materials - FramesUp to $100
Materials - Single Vision LensesUp to $25
Materials - Bifocal LensesUp to $40
Materials - Trifocal LensesUp to $60
Materials - Contact LensesUp to $160
Medically NecessaryUp to $210
PER PAYCHECK DEDUCTIONS
Employee:$4.38
Employee with Spouse:$8.76
Employee with Child(ren):$8.32
Employee with Family:$13.07
SPREADSHEET FOR ILLUSTRATIVE PURPOSES ONLY
PLEASE REFER TO INSURANCE CARRIER SUMMARY FOR DETAILS OF BENEFITS PROVIDED
BENEFITS ARE PAYABLE ACCORDING TO THE VISION INSURANCE CARRIER CERTIFICATE OF BENEFITS

Client- HUMANA Vision Monthly - HOURLY Per. Pay

Effective December 1, 2016
VOLUNTARY Group Vision Plan: HUMANA VISION 200
Product Type:Voluntary Enrollment
Deductible:None
Frequency:
Exam12 months
Lenses12 months
Frames24 months
In-Network Co-Pays:
Exam$0
Materials - Covered Frames$200 Allowance
Materials - Retail Frames20% Discount
Materials - Standard Lenses$0
Additional OptionsDiscounts
Contact Lenses - In lieu of Eyeglasses:
Exam (Evaluation and Fitting)$0
Exam (Current Wearers)$0
Materials - Covered Lenses$200 Allowance
Materials - Retail Lenses15% Discount
Medically NecessaryCovered in Full w/ pre-approval
Out-of-Network Allowance:
ExamUp to $30
Materials - FramesUp to $100
Materials - Single Vision LensesUp to $25
Materials - Bifocal LensesUp to $40
Materials - Trifocal LensesUp to $60
Materials - Contact LensesUp to $160
Medically NecessaryUp to $210
PER PAYCHECK DEDUCTIONS
Employee:$4.38
Employee with Spouse:$8.76
Employee with Child(ren):$8.32
Employee with Family:$13.07
SPREADSHEET FOR ILLUSTRATIVE PURPOSES ONLY
PLEASE REFER TO INSURANCE CARRIER SUMMARY FOR DETAILS OF BENEFITS PROVIDED
BENEFITS ARE PAYABLE ACCORDING TO THE VISION INSURANCE CARRIER CERTIFICATE OF BENEFITS

Client - Humana Medical SALARY

Effective December 1, 2016
Group Health Insurance Benefits
HUMANA INSURANCE - with SELECT Rx
Smpcty Opt2 Gold16 wRxSmpcty Opt3 Gold16 wRxSmpcty Opt1 Gold16 wRx
Physician Co-pay (In):$40$45$40
(Out):N/AN/ADed, 50%
PCP Selection Required:NoNoNo
Specialist Co-pay (In):$80$90$75
(Out):N/AN/ADed, 50%
PCP Referral Required:NoNoNo
Deductible (In):NoneNoneNone
(Out):N/AN/A$5,000 / $10,000
Emergency Room:$400$425$350
In-Patient Hospital (In):$1,250 per day (1-3 max)$1,500 per day (1-3 max)$750 per day (1-3 max)
(Out):N/AN/ADed, 50%
Out-Patient Surgery (In):$1,250 per Occ$1,500 per Occ$750 per Occ
(Out):N/AN/ADed, 50%
Urgent Care (In):$100$125$100
(Out):N/AN/ADed, 50%
Lab (In):$0$0$0
Simple X-Ray (In):$0$0$0
Complex X-Ray / Lab (In):$400$425$350
X-Ray / Lab (Out):N/AN/ADed, 50%
Out of Pocket Maximum (In):$6,000 / $12,000$6,000 / $12,000$6,000 / $12,000
(Out):N/AN/A$18,000 / $36,000
Includes Deductible:YesYesYes
Co-Insurance (In):100%100%100%
(Out):N/AN/A50%
Pharmacy (SELECT):$10 / $30 / $55 / 25%$10 / $30 / $55 / 25%$10 / $40 / $70 / 25%
Home Delivery (90-day Supply):2.5 X Co-Pay2.5 X Co-Pay2.5 X Co-Pay
Lifetime Maximum:UnlimitedUnlimitedUnlimited
PER. PAYCHECK DEDUCTIONS
HMO #1HMO # 2POS #3
Employee:$82.78$0.00$146.44
Employee w/ Spouse:$344.70$0.00$472.03
Employee w/ Child(ren):$305.41$0.00$423.19
Employee w/ Family:$567.33$0.00$748.78
SPREADSHEET FOR ILLUSTRATIVE PURPOSES ONLY
PLEASE REFER TO INSURANCE CARRIER SUMMARY FOR DETAILS OF BENEFITS PROVIDED
BENEFITS ARE PAYABLE ACCORDING TO THE HUMANA INSURANCE CERTIFICATE OF COVERAGE

Client- HUMANA Vision Monthly - HOURLY Per. Pay

Effective December 1, 2016
VOLUNTARY Group Vision Plan: HUMANA VISION 200
Product Type:Voluntary Enrollment
Deductible:None
Frequency:
Exam12 months
Lenses12 months
Frames24 months
In-Network Co-Pays:
Exam$0
Materials - Covered Frames$200 Allowance
Materials - Retail Frames20% Discount
Materials - Standard Lenses$0
Additional OptionsDiscounts
Contact Lenses - In lieu of Eyeglasses:
Exam (Evaluation and Fitting)$0
Exam (Current Wearers)$0
Materials - Covered Lenses$200 Allowance
Materials - Retail Lenses15% Discount
Medically NecessaryCovered in Full w/ pre-approval
Out-of-Network Allowance:
ExamUp to $30
Materials - FramesUp to $100
Materials - Single Vision LensesUp to $25
Materials - Bifocal LensesUp to $40
Materials - Trifocal LensesUp to $60
Materials - Contact LensesUp to $160
Medically NecessaryUp to $210
PER PAYCHECK DEDUCTIONS
Employee:$4.38
Employee with Spouse:$8.76
Employee with Child(ren):$8.32
Employee with Family:$13.07
SPREADSHEET FOR ILLUSTRATIVE PURPOSES ONLY
PLEASE REFER TO INSURANCE CARRIER SUMMARY FOR DETAILS OF BENEFITS PROVIDED
BENEFITS ARE PAYABLE ACCORDING TO THE VISION INSURANCE CARRIER CERTIFICATE OF BENEFITS

Client- HUMANA Vision Monthly - HOURLY Per. Pay

Effective December 1, 2016
VOLUNTARY Group Vision Plan: HUMANA VISION 200
Product Type:Voluntary Enrollment
Deductible:None
Frequency:
Exam12 months
Lenses12 months
Frames24 months
In-Network Co-Pays:
Exam$0
Materials - Covered Frames$200 Allowance
Materials - Retail Frames20% Discount
Materials - Standard Lenses$0
Additional OptionsDiscounts
Contact Lenses - In lieu of Eyeglasses:
Exam (Evaluation and Fitting)$0
Exam (Current Wearers)$0
Materials - Covered Lenses$200 Allowance
Materials - Retail Lenses15% Discount
Medically NecessaryCovered in Full w/ pre-approval
Out-of-Network Allowance:
ExamUp to $30
Materials - FramesUp to $100
Materials - Single Vision LensesUp to $25
Materials - Bifocal LensesUp to $40
Materials - Trifocal LensesUp to $60
Materials - Contact LensesUp to $160
Medically NecessaryUp to $210
PER PAYCHECK DEDUCTIONS
Employee:$4.38
Employee with Spouse:$8.76
Employee with Child(ren):$8.32
Employee with Family:$13.07
SPREADSHEET FOR ILLUSTRATIVE PURPOSES ONLY
PLEASE REFER TO INSURANCE CARRIER SUMMARY FOR DETAILS OF BENEFITS PROVIDED
BENEFITS ARE PAYABLE ACCORDING TO THE VISION INSURANCE CARRIER CERTIFICATE OF BENEFITS

 

 

 Aflac Benefit Summary

Aflac benefits are only paid to the policyholder.
The benefit dollars can be used anyway the policyholder wants so they can focus on the
situation they or a family member are dealing with.

Accident Advantage Plan: Aflac pays policyholder for the treatment of Accidental Injuries on or off the job
Initial Treatment benefit, follow up doctor visits, initial hospital admission benefit and daily hospital benefit, ICU benefits, treatment
benefits for follow up visits, physical therapy, life insurance for accidental death, plus many other benefits.
One $60 well ness benefit available per policy per year.
Hospital Advantage: Aflac pays policyholder for hospital admission for any health event whether it is due to an illness or an
injury. The hospital plan benefits includes: emergency room visits, physician visits, medical diagnostic and imaging, stays in a rehabilitation facility. This plan also has a Surgery Benefit for in patient or outpatient surgery and a benefit for invasive diagnostic exams such as a colonoscopy.
Cancer Care: According to the American Cancer Association, one out of three Americans will be diagnosed with cancer.
The Cancer Care Plan pays an initial diagnosis of an internal Cancer plus benefits for the following: Bone Marrow or Stem Cell
transplants, radiation treatments, chemotherapy, surgery, hospital stay, The plan covers transportation anywhere in the U.S., family
lodging, skin cancer coverage, ambulance benefit and many more benefits. Applications accepted through age 75.
Well ness benefit of $75 annually for a cancer screen for everyone covered under the plan.
Critical Illness & Recovery: Aflac pays an initial diagnosis benefit along with daily benefit for a hospital stay/Intensive Care
for treatment of a Heart Attack, Coma, Stroke, Paralysis, End-Stage Renal Failure, Major 3rd Degree Burns, Persistent Vegetative
State, or Coronary Artery Bypass Surgery. It pays $25,000 for Major Human Organ Transplants and many more benefits
Life Protector: Aflac life insurance has coverage from $10,000 to $500,000. The policy is available as a Term Policy for 10, 20 or
30 years or a Whole Life Policy which begins building a cash value starting in the third year the policy is in effect. Your spouse and
children can also be covered.
Short Term Disability: How important is your paycheck to your household? Short term disability will pay you a tax
free portion of your income while you are out of work due to an off the job accident or an illness (including maternity)
Aflac’s disability can be tailor made to your exact situation with a selection of benefit periods.