Limitations for Network Benefits. Medically Necessary Contact Lenses Medically Necessary Contact Lenses are subject to Authorization. Once Authorized, the Member will be able to choose any of the contact lens options available under this Article, subject to any corresponding copayment and allowance. Medically Necessary Contact Lenses that are not duly Authorized will not be covered. Collection and non-Collection Eyeglass Frames Members may choose either one Collection or one non-Collection Eyeglass Frame within their frequency period, but not both. Eyeglass Frame and Contact Lens Coverages Subject to an Allowance When according to the Schedule of Vision Benefits, Eyeglass Frame or Contact Lens coverage is limited to a maximum allowance, that means that those items are covered, after their corresponding copayment, up to their retail value stated in the Schedule. If the Member chooses an item which retail value exceeds the allowance, the Member will have to pay the excess in addition to the applicable copayment. The Member may be given a discount from the frames or lenses’ retail value in excess of the allowance. Any discounts over an item’s retail value in excess of the allowance will not be available if the Member purchases his/her item from a Costco, Walmart or Sam’s Club location. Eyeglass Frames purchased at Visionworks locations may have a higher maximum allowance than if purchased from other locations, if stated in the Schedule of Vision Benefits. Contact Lens Evaluation, Fitting and Follow-up Care Evaluation, Xxxxxxx and follow-up care coverage for Contact Lenses are described in the Schedule of Vision Benefits. Evaluation, Fitting and follow up care may not be covered for certain types of contact lenses, may be covered in full subject to a copayment, or may be covered up to a specific fee value (the “allowance”). Evaluation, Fitting and follow-up care fee values which exceed the allowance will require the Member to pay the excess fee in addition to any applicable copayments and any other fees. Discounts over Evaluation and Fitting fees in excess of any allowance may be available. Any discounts will not be available if the Member purchases his/her Contact Lenses from a Costco, Walmart or Sam’s Club location. Out-of-Network Benefits If included according to the Schedule of Vision Benefits, this Benefit Plan will provide limited coverage for certain services and materials given by Non-Participating Providers, up to the maximum reimbursement amount described in the Schedule. Any char...
Limitations for Network Benefits. 1. Medically Necessary Contact Lenses Medically Necessary Contact Lenses are subject to Authorization. Once Authorized, the Member will be able to choose any of the contact lens options available under this Article, subject to any corresponding copayment and allowance. Medically Necessary Contact Lenses that are not duly Authorized will not be covered.
