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Vision Plan At-A-Glance
VISION PLAN
Angeles Contractor, Inc. offers you and your eligible
dependents vision benefits through Humana. This plan
provides coverage for routine eye exams, lenses and
frames, and contact lenses. The following benefits apply
when you visit a Humana network provider. To find a
provider please visit www.Humana.com.
HUMANA VISION
SERVICES IN-NETWORK OUT-OF-NETWORK
Copays
$10 Exam Up to $30
Frequencies Exams: 12 months from last date of service
Lenses: 12 months from last date of service
Frames: 24 months from last date of service
Eye Exam $10 co-pay Up to $30.00
LENSES
Single Vision $15 co-pay Up to $25.00
Bifocal $15 co-pay Up to $40.00
Trifocal $15 co-pay Up to $60.00
FRAMES
Any Frame Available Up to $130.00, 20% off Up to $65.00
balance over $130
CONTACT LENSES
Medically Necessary $0 co-pay Up to $200.00
Elective Up to $130.00 Up to $104.00
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