Vision Benefits - Gemini

HMSA Preferred Provider Plan (PPO)

VISION - Adults - member responsibility
BENEFIT HIGHLIGHTS IN-NETWORK OUT-OF-NETWORK
Eye Exam - Once per calendar year $10 copay

100% less $40

Lenses (Single) - One per calendar Year $15 copay 100% less $16
Frames - One every 24 months $15 copay - from a chosen group Any frame outside that group, the member pays the difference. 100% less $12

 

VISION - Children thru age 18 - member responsibility
BENEFIT HIGHLIGHTS IN-NETWORK OUT-OF-NETWORK
Frames - One every 12 months $15 copay - from a chosen group Any frame outside that group, the member pays the difference. 50% of eligible charges

HMSA Health Plan Hawaii Plus (HMO)

VISION - Adults - member responsibility
BENEFIT HIGHLIGHTS IN-NETWORK OUT-OF-NETWORK
Eye Exam - Once per calendar year $20 copay

Not covered

Lenses (Single) - One per calendar Year $10 copay 100% less $16
Frames - One every 24 months $15 copay - from a chosen group Any frame outside that group, the member pays the difference. 100% less $12
VISION - Children thru age 18 - member responsibility
BENEFIT HIGHLIGHTS IN-NETWORK OUT-OF-NETWORK
Frames - One every 12 months $15 copay - from a chosen group Any frame outside that group, the member pays the difference. 100% less $12

Kaiser Added Choice - Optical 150 (Vision)

  • In-Network - All costs greater than a $150 allowance once every calendar year for glasses OR contact lenses
  • Out-Of-Network - $50 total allowance for lenses, frames and contacts

Kaiser HMO - Optical 150 (Vision) In-Network

  • All costs greater than a $150 allowance once every calendar year for glasses OR contact lenses