Vision Care Services. For purposes of coordination of benefits, vision care services covered under other plans are not considered an allowable expense, as defined in the Coordination of Benefits and Subrogation in Section 7.
Vision Care Services. All vision services for Members are described in the Department’s Physicians, Laboratories, and Other Medical Professionals Provider Manual. The CONTRACTOR shall:
4.2.25.1. Be responsible for all vision services for Members under twenty-one
Vision Care Services. Eye exercises and visual training services. Lenses and/or frames and contact lenses unless specifically listed as a covered healthcare service. Services performed by a provider who has been excluded or debarred from participation in federal programs, such as Medicare and Medicaid. To determine whether a provider has been excluded from a federal program, visit the U.S. Department of Human Services Office of Inspector General website (xxxxx://xxxxxxxxxx.xxx.xxx.xxx/) or the Excluded Parties List System website maintained by the U.S. General Services Administration (xxxxx://xxx.xxx.gov/). Services provided by facilities, dentists, physicians, surgeons, or other providers who are not legally qualified or licensed, according to relevant sections of Rhode Island Law or other governing bodies, or who have not met our credentialing requirements. Services provided by a non-network provider, unless listed as covered in the Summary of Medical Benefits. Services provided by naturopaths, homeopaths, or Christian Science practitioners.
Vision Care Services. All vision services for Members are described in the Department’s Physicians, Laboratories, and Other Medical Professionals Provider Manual. The CONTRACTOR shall:
4.2.28.1. Be responsible for all vision services for Members under twenty-one (21) years of age and limited Benefits for adults over twenty-one (21) years of age.
4.2.28.2. Be responsible for the same level of vision Benefits and services covered under the Medicaid FFS Program and refer to the Department’s Managed Care Policies and Procedures Guide and other applicable manuals regarding Benefits.
4.2.28.3. Have the discretion to use an approach to coverage that differs from the Medicaid FFS Program.
Vision Care Services. Routine Vision Exam One routine vision exam per member per plan year $0 20% - After deductible One routine vision exam when performed to treat members with diabetes. $0 20% - After deductible Non-routine vision exam $0 20% - After deductible Covered Benefits - See Covered Healthcare Services for additional benefit limits and details. Network Providers Non-network Providers (*) Preauthorization may be required for this service. Please see Preauthorization in Section 5 for more information. You Pay You Pay Pediatric Vision Care for members under age 19: See Vision Services in Section 3 for benefit limits and details. These services only apply to an enrolled member under the age of 19: Prescription glasses - Frame and lenses 0% Not Covered Contact lens (in lieu of prescription glasses) 0% Not Covered Vision hardware for enrolled members aged 19 and older. Not Covered Not Covered The Summary of Pharmacy Benefits only applies to prescription drugs purchased at a retail, mail order, or specialty, pharmacy. For information about our pharmacy network, visit our website or call our Customer Service Department.
Vision Care Services. Routine Vision Exam One routine vision exam per member per plan year $0 Not Covered One routine vision exam when performed to treat members with diabetes. $0 Not Covered Routine Vision Exam $0 Not Covered The Summary of Pharmacy Benefits only applies to prescription drugs purchased at a retail, mail order, or specialty, pharmacy. For information about our pharmacy network, visit our website or call our Customer Service Department.
Vision Care Services. Contractor shall ensure a vision care services system, consistent with good professional practice, which provides that a Member may be seen initially by either of the following:
a) An optometrist or an ophthalmologist; or
b) A PCP before referral to an optometrist or an ophthalmologist. Contractor shall provide ophthalmic lenses in accordance with Subsection 7.6.5.
Vision Care Services. Provider agrees to:
a. Identify Inmates who need vision care services by using standardized screening tools as part of the initial health assessment and during routine chronic care and preventive visits.
b. Provide timely evaluation and treatment of Inmates who may have visual problems and/or may need vision care services.
c. Provide and cover to Inmates the cost of eyeglasses and other visual aids determined medically necessary.
d. Work closely with the DDOC ADA coordinator and the Delaware Division for the Visually Impaired and other relevant organizations to ensure that all technology, support services and appropriate accommodations are provided for visually impaired (blind) Inmates.
Vision Care Services. Routine Vision Exam One routine vision exam per member per plan year $0 20% - After deductible One routine vision exam when performed to treat members with diabetes. $0 20% - After deductible Non-routine vision exam $0 20% - After deductible Pediatric Vision Care for members under age 19: See Vision Services in Section 3 for benefit limits and details. These services only apply to an enrolled member under the age of 19: Prescription glasses - Frame and lenses 0% Not Covered Contact lens (in lieu of prescription glasses) 0% Not Covered Vision hardware for enrolled members aged 19 and older. Not Covered Not Covered
Vision Care Services. Routine Vision Exam One routine vision exam per member per plan year $55 Not Covered One routine vision exam when performed to treat members with diabetes. $0 Not Covered Non-routine vision exam $45 Not Covered Pediatric Vision Care for members under age 19: See Vision Services in Section 3 for benefit limits and details. These services only apply to an enrolled member under the age of 19: Prescription glasses - Frame and lenses 0% Not Covered Contact lens (in lieu of prescription glasses) 0% Not Covered Vision hardware for enrolled members aged 19 and older. Not Covered Not Covered The Summary of Pharmacy Benefits only applies to prescription drugs purchased at a retail, mail order, or specialty, pharmacy. For information about our pharmacy network, visit our website or call our Customer Service Department.
