may need advance approval from your plan. This is called a"prior authorization" or "preauthorization." Please 
contact your PCP or refer to the Evidence of Coverage (EOC) for services that require aprior authorization from the 
plan .
c
H5216107000SB23 Summary of Benefits 11 H5216107000 
Covered Medical and Hospital Benefits  (cont.) 
IN-NETWORK OUT-OF-NETWORK 
Routine vision  
The provider locator for routine 
vision can be found at  
Humana.com >Find aDoctor > 
select Vision care icon >Vision