Vision Care Services Clause Samples
The Vision Care Services clause defines the scope and terms under which vision-related healthcare benefits are provided to eligible individuals. It typically outlines what types of eye care services are covered, such as routine eye exams, prescription lenses, frames, and sometimes contact lenses, as well as any limitations or exclusions. By clearly specifying the extent of vision care benefits, this clause ensures that both the provider and the recipient understand what services are included, thereby preventing misunderstandings and disputes over coverage.
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 (▇▇▇▇▇://▇▇▇▇▇▇▇▇▇▇.▇▇▇.▇▇▇.▇▇▇/) or the Excluded Parties List System website maintained by the U.S. General Services Administration (▇▇▇▇▇://▇▇▇.▇▇▇.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:
4.2.29.1 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.
4.2.29.2 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.
4.2.29.3 Have the discretion to use an approach to coverage that differs from the Medicaid FFS Program.
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 applicable Provider 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 $55 Not Covered One routine vision exam when performed to treat members with diabetes. $0 Not Covered Non-routine eye 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
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. The routine eye examination described in this Rider.
Vision Care Services. Subject to definitions, terms and conditions in the AOC, an Insured is entitled to receive the vision care services set forth in this Rider. The Insured shall be entitled to vision care services only if a Provider prescribes Lenses and Frames and the prescription was ordered while the Insured was enrolled in SHL.
(1) vision examination by a Provider to include examination by a Plan Subject to limitation. complete analysis of the eyes and related structures to Provider. Subject to determine the presence of vision problems or other limitation. Lenses (Plastic) One (1) pair of Lenses will be provided during any twelve (12) consecutive calendar month period, when a prescription change is determined Medically Necessary by a Provider. Lenses are limited to single vision, bifocal, trifocal, lenticular and other complex Lenses. $10 copay for one pair of Lenses (Plastic). Subject to limitation. $25 maximum allowance for single vision lenses. Subject to limitation. $40 maximum allowance for bifocal lenses. Subject to limitation. $55 maximum allowance for trifocal or lenticular lenses. Subject to limitation. Frames Expenses incurred in connection with Frames, from an approved frame selection will be considered covered vision expenses once during each twenty-four (24) consecutive calendar month period. Charges for Frames in excess of the maximum allowance shall be the responsibility of the Subscriber. Discounts may be available through the Provider for those charges in excess of the maximum allowance. $100 maximum allowance. Subject to limitation. $45 maximum allowance. Subject to limitation. Form No. SHL AdultVisionRider IND (2014) Page 1 41NVSHLAOC_AdultVision_Ind_2014 Contact Lenses Expenses incurred in connection with the purchase of one (1) pair of Contact Lenses prescribed by a Provider may be considered covered vision expense on the condition that the Subscriber elects to receive an allowance for the purchase of such Contact Lenses in lieu of all other vision benefit once during any twelve (12) consecutive month period (with the exception of the annual vision examination which shall continue to be available). Charges for Contact Lenses in excess of the Maximum allowance shall be the responsibility of the Subscriber. Discounts may be available through the Provider for those charges in excess of the maximum allowance. $250 maximum allowance for medically necessary Contact Lenses. Subject to limitation. $115 maximum allowance for conventional or disposable Contact...