Contact Lenses. Medically Necessary: The Plan will cover medically necessary contact lenses once every twelve (12) months with an employee co-payment identified in Appendix K-4. Medically necessary means (a) must correct the member’s acuity to 20/70 or better in the better eye or (b) the member has one of the following visual conditions: kerataconus, irregular astigmatism, or irregular corneal curvature. Not Medically Necessary: The Plan will pay a maximum allowance identified in Appendix K-4 and the employee shall pay any additional charge of the provider for such contact lenses. The contact lens evaluation is included in the cost of the contact lens allowance.
Contact Lenses. We provide a discount on the initial fitting for contact lenses at a Xxxxxx Permanente Optical Shop. Initial fitting means the first time you have ever been examined for contact lens wear at a Plan Facility. The discount includes the following services:
Contact Lenses. Medically necessary as defined in Section 3.b.3 above. $96.00/Pair Not medically necessary $40.00/Pair
Contact Lenses. The Parties acknowledge that they contemplate that under this Agreement, Manager will initially sell contact lenses on its own behalf from non-California Offices and the Centers and that, upon notification from Walmart, Manager will sell contact lenses on behalf of Walmart under this Agreement (the effective date of such notification, the “Contact Lens Transition Date”). Walmart agrees to reasonably cooperate with Manager in connection with the Contact Lens Transition Date and to, among other matters, provide Manager with thirty days’ notice of such date.
Contact Lenses. Will be covered in full when they are considered necessary under one of the following conditions:
Contact Lenses lenses made of various materials, either rigid or flexible, that fit over the cornea and may extend to the sclera of the eye in order to correct refractive errors.
Contact Lenses. The Plan must cover medically necessary contact lenses in at least the following instances: • Following cataract surgery • To correct extreme visual acuity problems that cannot be corrected to 20/70 in the better eye with glasses • Certain conditions of anisometropia and keratoconus • When deemed necessary by a medical provider
Contact Lenses. Medically Necessary Covered in Full Limited to $175.00, member pays balance Cosmetic Covered up to $90 & Limited to $90.00, member pays balance additional 20% of balance. Benefit Frequency = Once every 12 months. APPENDIX 2 CENTREVILLE PUBLIC SCHOOLS DENTAL SUMMARY OF BENEFITS Silver Dental Program DENTAL PLAN BENEFIT SCHEDULE CO-PAY Class I 60% Preventative Care: Oral examinations every six consecutive months Teeth cleaning every six consecutive months Bitewing X-rays every six consecutive months Full-mouth X-rays routinely every three years Fluoride treatment for members of all ages Palliative emergency treatment Tests and Laboratory examinations Class II 60% Restorative Care: Acrylic, amalgam, or silicate fillings Root canal therapy Pulp capping Periodontics treatment Gingivitis treatment Extractions – simple and surgical Repairs to existing dentures and bridge Relining and rebasing of existing dentures General anesthesia Class III 60% Replacement Care: Construction of dentures or bridges Crowns, inlays, and onlays Removable dentures – complete and partial Fixed bridges Bridge pontics and abutment crowns Replacement of dentures and bridges after 5 years and if unserviceable Class IV 60% Orthodontic Care: Habit-breaking appliances Appliance construction and installation Full banding treatment Monthly active treatment visits Annual Maximum on Classes I, II, and III $1,000.00 Lifetime Maximum on class IV $ 600.00 Gold Dental Program DENTAL PLAN BENEFIT SCHEDULE CO-PAY Class I 100% Preventative Care: Oral examinations every six consecutive months Teeth cleaning every six consecutive months Bitewing X-rays every six consecutive months Full-mouth X-rays routinely every three years Fluoride treatment for members of all ages Palliative emergency treatment Tests and Laboratory examinations Class II 80% Restorative Care: Acrylic, amalgam, or silicate fillings Root canal therapy Pulp capping Periodontics treatment Gingivitis treatment Extractions – simple and surgical Repairs to existing dentures and bridge Relining and rebasing of existing dentures General anesthesia Class III 80% Replacement Care: Construction of dentures or bridges Crowns, inlays, and onlays Removable dentures – complete and partial Fixed bridges Bridge pontics and abutment crowns Replacement of dentures and bridges after 5 years and if unserviceable Class IV 80% Orthodontic Care: Habit-breaking appliances Appliance construction and installation Full banding treatment Monthly active treatment v...
Contact Lenses. Provided one time in each Calendar Year in lieu of lenses and/or frames.
Contact Lenses when medically necessary for ulcerated keratitis, severe corneal scarring, keratoconus or aphakia, provided sight can be improved to at least the 20/40 level. The maximum eligible expense in any two consecutive calendar year period is $200.00. Visual Training - visual training and remedial eye exercises up to a maximum lifetime eligible expense of $150.00.
