Pediatric Vision Coverage Clause Samples
The Pediatric Vision Coverage clause defines the health insurance benefits provided for vision care services specifically for children, typically under the age of 19. This clause outlines what pediatric vision services are included, such as routine eye exams, prescription glasses, or contact lenses, and may specify frequency limits or cost-sharing requirements. Its core practical function is to ensure that children covered under the policy have access to essential vision care, addressing early detection and correction of vision problems to support healthy development.
Pediatric Vision Coverage. A. When the Member receives a vision examination from a Contracting Vision Provider, the benefit payment is accepted as payment in full.
B. When a Member receives frames and spectacle lenses or contact lenses from a Contracting Vision Provider, the Member’s responsibility is as stated below. The benefit payment is as stated in the attached Schedule of Benefits.
1. When the Member receives frames from the display of collection frames (the collection designated by the Vision Care Designee) and basic spectacle lenses from a Contracting Vision Provider, the benefit payment is accepted as payment in full.
2. When the Member receives other frames, non-basic spectacle lenses or contact lenses from a Contracting Vision Provider, the Member is responsible for the cost difference between the Vision Care Designee’s payment and the Contracting Vision Provider’s actual charge.
C. When the Member receives Covered Vision Services from a Non-Contracting Vision Provider, the Member is responsible for the cost difference between the Vision Care Designee’s payment and the Non-Contracting Vision Provider’s actual charge. The Vision Care Designee’s payment is stated in the Schedule of Benefits.
D. Limited Access Area: If the Member resides in an area that does not have adequate access to a Contracting Vision Provider and the Member receives Vision Care from a Non-Contracting Vision Provider, the Vision Care Designee will pay up to 100% of the Allowed Benefit. The Member is responsible for any difference between the amount billed and the Vision Care Designee’s payment. To determine if the Member resides in a limited access area, the Member must call the Vision Care Designee at the telephone number on the Member’s identification card.
Pediatric Vision Coverage. 1. When the Member receives a vision examination from a Contracting Vision Provider, the benefit payment is accepted as payment in full.
2. When a Member receives frames and spectacle lenses or contact lenses from a Contracting Vision Provider, the Member’s responsibility is as stated below. The benefit payment is as stated in the attached Schedule of Benefits.
a. When the Member receives frames from the display of collection frames (the collection designated by the Vision Care Designee) and basic spectacle lenses from a Contracting Vision Provider, the benefit payment is accepted as payment in full.
b. When the Member receives other frames, non-basic spectacle lenses or contact lenses from a Contracting Vision Provider, the Member is responsible for the cost difference between the Vision Care Designee’s payment and the Contracting Vision Provider’s actual charge.
3. When the Member receives Covered Vision Services from a Non-Contracting Vision Provider, the Member is responsible for the cost difference between the Vision Care Designee’s payment and the Non-Contracting Vision Provider’s actual charge. The Vision Care Designee’s payment is stated in the Schedule of Benefits.
Pediatric Vision Coverage. A. When the Member receives a vision examination from a Contracting Vision Provider, the benefit payment is accepted as payment in full.
B. When a Member receives frames and spectacle lenses or contact lenses from a SAMPLE Contracting Vision Provider, the Member’s responsibility is as stated below. The benefit payment is as stated in the attached Schedule of Benefits.