The Spectera Vision Plan provides partial payment to help you offset the costs of annual eye exams (which are also covered under Uniform Benefits), frames, lenses and contact lenses. It also provides a discounted refractive eye surgery at select locations.

Eligibility

You must be employed by the University of Wisconsin and be eligible for immediate or future employer contribution to the State of Wisconsin Health Insurance Program to participate. Unclassified faculty, academic staff and short-term academic staff appointees, classified employees (including LTE's covered by the retirement system), graduate assistants, fellows and scholars and employees in-training are eligible to enroll in this vision plan.

Eligible dependents of these employees may enroll as dependents of the employee. Domestic partners and their children are eligible under this plan.

Rehired annuitants receiving a Wisconsin Retirement System benefit are not eligible for this program.

WRS annuitants who are not covered under Spectera at the time of retirement may enroll during the open enrollment period by applying through the Department of Employee Trust Funds. Non-covered annuitants can click here for additional information.

Enrollment

If you want coverage in the Spectera Vision plan to begin as soon as possible, you must submit an application to your staff benefits specialist no later than 31 calendar days from the begin date of your appointment. Coverage will begin on the first of the month on or after your campus benefits office receives your application.

You may also enroll during an Open Enrollment period. Open enrollment periods are offered annually to coincide with the Dual-Choice Enrollment period for health insurance.

You can print an application here.

Coverage  

If you use a Spectera vision provider, this plan will cover:

• One vision exam per 12-month period with a $10 copayment.
• After a $25 copayment:
  • One pair of frames per 24-month period.
  • One pair of eyeglass lenses per 12-month period (you only pay one $25 copayment if you purchase frames and lenses together).
  • Contact lenses (including up to four boxes of disposable contact lenses). Contacts and frames cannot be purchased in the same 12-month period.

If you or your covered family members use a Spectera vision provider, simply provide the member's name and birth date and the employee's social security number (alternate ID numbers may be requested).

You may also see a non-Spectera vision provider but you will likely experience higher out of pocket costs. You will also have to pay the charges at the time of service and file a claim with Spectera to receive reimbursement.

To locate a Spectera provider near you, you can call Spectera's IVR line at 1-800-839-3242 or you can log on to www.spectera.com , click on Members and Future Members and enter your zip code.

View a benefit description or a summary of the coverage. Since enhancements to lenses are the members responsibility, such as tinting, please see these Patient Options.

Important Note: If you enroll in Spectera, you must remain in the plan for 12 months. To terminate coverage, you must notify your benefits office in writing by December. Coverage will end on December 31. Mid-year cancellation is only possible due to termination of employment or death.

Premiums  

The monthly premiums for the Spectera Vision Plan are:

Employee Only:	$ 5.83
Employee + Spouse:	$11.34
Employee + Child(ren):	$11.88
Employee + Family:	$17.82

Premiums are deducted on pre-tax basis. At this time, due to IRS regulations, the premium for LTEs and employees who enroll with a domestic partner cannot be taken pre-tax.

Premiums are paid one month in advance of the coverage month. For classified, the premiums will be deducted from the A payroll.

For more information about the Spectera Vision plan, please click on Frequently Asked Questions .

This document was last revised on January 2, 2008