A plan administered by Optima Health which offers a solid benefits package to active employees and their enrolled dependents.
COVA Connect Optional Benefits
1. Out-Of-Network Benefit
This option allows you to receive covered services at a reduced level from non-network providers-that is, providers that are not in the Optima Health PPO anetwork. The plan payment for covered services is reduced by 25%. You are responsible for any applicable deductible, copayment or coinsurance. You also pay any balance above the allowable charge. Claims payments are made directly to the member when services are received from a non-network provider.
2. Expanded Dental Benefit
This option allows you to add Complex Restorative and Orthodontic benefits to your basic dental benefits. The maximum the plan pays each calendar year for the basic dental and complex restorative is $300 more than under the COVA Connect basic plan.
The COVA Connect basic plan includes coverage for routine diagnostic and preventive, and primary dental services. The Expanded dental option described earlier in this section adds benefits for prosthetic and complex restorative services and orthodontic services.3. Vision, Hearing and Expanded Dental Option
The Vision, Hearing and Expanded Dental option adds coverage for certain vision care services, and all the benefits of the expanded dental option described earlier in this section.Vision Services
The Vision, Hearing and Expanded Dental option adds coverage for certain vision care services to identify and correct refractive error. Benefits are provided up to a maximum payment established for each covered service. These services may be obtained from an optometrist, optician, or ophthalmologist. The following services are covered:
- an eye examination once every 24 months (you pay $40 copayment);
- one set of frames every 24 months ($100 benefit maximum);
- one pair of single, bifocal, or trifocal eyeglass lenses every 24 months; $20 co-pay or contact lenses of any type ($100 benefit maximum), instead of eyeglass lenses, every 24 months.
The Vision, Hearing and Expanded Dental option adds coverage for certain hearing care services to identify and treat hearing loss. Benefits are provided up to a maximum payment established for each coverage service. The examination may be obtained from an audiologist or doctor of medicine.
The following services are covered:
OPTIONAL BENEFITS COMBINATIONS
- an examination once every 48 months (you pay $40 copayment); and
- hearing aid(s) and other related hearing aid services such as selection and fitting every 48 months ($1,200 benefit maximum)
The three benefit options--Out-Of-Network, Expanded Dental, and Vision, Hearing and Expanded Dental--may be added to your standard COVA Connect plan as follows:
1. COVA Connect with Out-Of-Network Benefits
2. COVA Connect with Expanded Dental Benefits
3. COVA Connect with Routine Vision, Hearing and Expanded Dental Benefits
4. COVA Connect with Out-Of-Network Benefit and Expanded Dental Benefits
5. COVA Connect with Out-Of-Network Benefit and Routine Vision, Hearing and Expanded Dental Benefits