Optical Services. CONTRACTOR shall provide for Optical Services, including eye examinations performed on-site and in accordance with FDC rules, policies, procedures and HSBs. A qualified optometrist shall examine inmates with specific complaints. Eyeglasses shall be provided at the inmate’s expense unless clinically mandated by an ophthalmologist at which time CONTRACTOR is financially responsible. Eyeglasses shall be obtained by CONTRACTOR through Prison Rehabilitative Industries and Diversified Enterprises, Inc. (PRIDE).
Optical Services. The term “Optical Services” shall mean the filling of optical prescriptions, dispensing of optical goods, the fitting of eyewear, all activities related to any of the foregoing, and the direction, supervision, and control of those who perform these tasks.
Optical Services. Routine eye examinations and refractions received at a GHC Facility once every twelve (12) months, except when Medically Necessary. Routine eye examinations to monitor Medical Conditions are covered as often as necessary upon recommendation of a GHC Provider. Contact lenses for eye pathology, including contact lens exam and fitting, are covered subject to the applicable Cost Share. When dispensed through GHC Facilities, one contact lens per diseased eye in lieu of an intraocular lens, including exam and fitting, is covered for Members following cataract surgery performed by a GHC Provider, provided the Member has been continuously covered by GHC since such surgery. Replacement of lenses for eye pathology, including following cataract surgery, will be covered only once within a twelve (12) month period and only when needed due to a change in the Member’s Medical Condition. Replacement for loss or breakage is subject to the Lenses and Frames benefit Allowance.
Optical Services. Routine eye examinations and refractions received at a GHC Facility once every twelve (12) months, except when Medically Necessary. When dispensed through GHC Facilities, one contact lens per diseased eye in lieu of an intraocular lens, including exam and fitting, is covered for Members following cataract surgery performed by a GHC Provider, provided the Member has been continuously covered by GHC since such surgery. Replacement of a covered contact lens will be covered only when needed due to a change in the Member’s Medical Condition, but no more than once in a twelve (12) month period. Excluded: evaluations and surgical procedures to correct refractions not related to eye pathology and complications related to such procedures, and contact lens fittings and related examinations, except as set forth above.
Optical Services. Routine eye examinations Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment once every twelve (12) months. Eye examinations, including contact lens examinations, for eye pathology are covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment as often as Medically Necessary. • Lenses, including contact lenses, and frames Eyeglass frames, lenses (any type), lens options such as tinting, or prescription contact lenses, contact lens evaluations and examinations associated with their fitting - Covered up to $200 per twenty-four
Optical Services. MHCN: Routine eye examinations and refractions received at a MHCN Facility once every twelve (12) months, except when Medically Necessary. When dispensed through MHCN Facilities, one contact lens per diseased eye in lieu of an intraocular lens, including exam and fitting, is covered for Members following cataract surgery performed by a MHCN Provider, provided the Member has been continuously covered by GHO since such surgery. Replacement of a covered contact lens will be covered only when needed due to a change in the Member’s Medical Condition, but no more than once in a twelve (12) month period. Excluded: evaluations and surgical procedures to correct refractions not related to eye pathology and complications related to such procedures, and contact lens fittings and related examinations, except as set forth above. Community Provider: Eye examinations for eye pathology when Medically Necessary. One contact lens per diseased eye in lieu of an intraocular lens, including exam and fitting, is covered for Members following cataract surgery, provided the Member has been continuously covered by GHO since such surgery. Replacement of a covered contact lens will be covered only when needed due to a change in the Member’s Medical Condition, but no more than once in a twelve (12) month period. Excluded: routine eye examinations and refractions, evaluations and surgical procedures to correct refractions not related to eye pathology and complications related to such procedures, and contact lens fittings and related examinations, except as set forth above.
Optical Services. 5.32.7.1. CONTRACTOR shall provide for Optical Services, including eye examinations performed on-site and in accordance DC policy, procedure and HSB. Eyeglasses shall be provided at the inmate’s expense unless clinically mandated by an ophthalmologist whereby CONTRACTOR is financially responsible.
Optical Services. Routine eye examinations Covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment once every twelve (12) months. Eye examinations, including contact lens examinations, for eye pathology are covered subject to the lesser of GHC’s charge or the applicable outpatient services Copayment as often as Medically Necessary. • Lenses, including contact lenses, and frames EMPLOYEES ONLY: Eyeglass frames, lenses (any type), lens options such as tinting, or prescription contact lenses, contact lens evaluations and examinations associated with their fitting - Covered up to $200 per twenty-four (24) month period per Member. The benefit period begins on the date services are first obtained and continues for twenty-four (24) months. DEPENDENTS ONLY: Eyeglass frames, lenses (any type), lens options such as tinting, or prescription contact lenses, contact lens evaluations and examinations associated with their fitting - Covered up to $50 per twenty-four (24) month period per Member. The benefit period begins on the date services are first obtained and continues for twenty-four (24) months • Contact lenses for eye pathology, including following cataract surgery - Covered in full. Organ Transplants Covered subject to the lesser of GHC’s charge or the applicable Copayment. Plastic and Reconstructive Services (plastic surgery, cosmetic surgery) • Surgery to correct a congenital disease or anomaly, or conditions following an injury or resulting from surgery Covered subject to the lesser of GHC’s charge or the applicable Copayment. • Cosmetic surgery, including complications resulting from cosmetic surgery Not covered.
