Important Note:
Effective January 1, 2022, HMSA has partnered with EyeMed for routine vision services for the following lines of business: Commercial, Akamai Advantage®, QUEST Integration, Fed 87, and HMSA Plan for Postal Service Employees.
Non-routine vision services remain under our medical benefit and will be processed as such.
For more information, please visit EyeMed at www.eyemedinfocus.com or contact by phone 1-888-259-4344.
The following examples apply to services associated with routine vision conditions (e.g. services performed and appliances furnished to correct refractive errors). Services rendered to treat a patient’s medical condition are not addressed in these examples.
Example A: Two HMSA Special Vision Care riders (same benefits)
When coordinating between two HMSA Special Vision Care riders with the same benefits, the primary plan will pay 100 percent of the eligible charge after member copayment, and the secondary plan will coordinate up to the eligible charge.
| Service | Special Vision AI – Primary plan pays: | Special Vision AI – Secondary plan pays: | Member pays |
|---|---|---|---|
| Exam | 100% after $10 copayment | $10 copayment | 0 |
| Single Vision Lenses | 100% after $10 copayment | $10 copayment | 0 |
| Standard Frames | 100% after $15 copayment | $15 copayment | 0 |
Payment of benefits will be made to the participating Special Vision provider.
Example B: Two HMSA Special Vision Care riders (different benefits)
| Service | Special Vision G – Primary plan pays: | Special Vision AI – Secondary plan pays: | Member pays |
|---|---|---|---|
| Exam | 100% after $5 copayment | $5 copayment | 0 |
| Single Vision Lenses | 100% | 0 | 0 |
| Nonstandard Frames | $75 | 0 | Any amount over $75 |
In this example, the member is responsible for the extra charges, in excess of $75, associated with the nonstandard frames. Payment of benefits will be made to the participating Special Vision provider.
Example C: Another carrier’s vision plan and an HMSA Special Vision Care rider
When another carrier’s vision plan is primary to an HMSA Special Vision Care rider, the HMSA Special Vision Care rider will coordinate to HMSA’s eligible charge for the service or appliance.
| Service | Another Carrier – Primary plan pays: | Special Vision AI – Secondary plan pays: | Member pays |
|---|---|---|---|
|
Exam Single Vision Lenses Frames |
The other carrier’s combined payment for exam, single vision lenses and standard frames is $75. | Remaining balance up to 100% of the eligible charge for each service* | 0** |
*Because the other carrier’s payment will cover the Special Vision Care Rider copayments, additional payment will be made by the Special Vision Care Rider up to 100% of the Special Vision eligible charge for each service. Any remaining charges are adjusted by the provider.
**If the other carrier’s total payment exceeds HMSA’s total eligible charges for the services, no additional payment will be made by HMSA and the provider may not bill the member for any remaining balance.
Payment of the secondary benefit will be made to the participating Special Vision provider.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |