Orthotics. This benefit covers the fitting and purchase of braces, splints, orthopedic appliances, and Orthotic supplies or apparatuses used to support, align or correct deformities or to improve the function of moving parts of the body. This benefit does not cover off-the shelf shoe inserts or orthopedic shoes. Pediatric vision services, including professional fees, supplies and materials, are covered for children under the age of 19, according to the limitations described in the Schedule of Benefits. Covered services include: • Routine vision screening and eye exam, with dilation and refraction; • Prescription lenses or contacts, including polycarbonate lenses and scratch resistant coating; • Lenses may include single vision, conventional lined bifocal or trifocal, or lenticular lenses; • One pair of frames or contact lenses, in lieu of lenses and frames, once per Calendar Year; • Evaluation, xxxxxxx and follow up care; and • Low vision optical devices, services, training and instruction. In addition to the applicable exclusions and plan limitations, the following services and materials are not covered by the pediatric vision benefit: • Orthoptics or vision training and any associated supplemental testing; • Plano lenses (less than ± .50 diopter power); • Two pair of glasses in lieu of bifocals; • Replacement of lenses and frames furnished under this plan which are lost or broken, except at the normal intervals when services are otherwise available; • Medical or surgical treatment of the eyes (these services are covered under your medical benefits); • Corrective vision treatments that are considered Experimental or Investigational; and • Costs for services and materials above the limitations indicated in the Schedule of Benefits.
Appears in 4 contracts
Samples: Health Care Coverage Agreement, Health Care Coverage Agreement, Health Care Coverage Agreement
