Medically Necessary Contact Lenses definition

Medically Necessary Contact Lenses means contact lenses that are determined to be Medically Necessary and appropriate in the treatment of patients affected by certain conditions. In general, contact lenses may be Medically Necessary and appropriate when the use of contact lenses, in lieu of eyeglasses, will result in significantly better visual and/or improved binocular function, including avoidance of diplopia or suppression. Contact lenses may be determined to be Medically Necessary in the treatment of the following conditions: Keratoconus, Pathological Myopia, Aphakia, Anisometropia, Aniseikonia, Aniridia, Corneal Disorders, Post-traumatic Disorders, and Irregular Astigmatism.
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Medically Necessary Contact Lenses means Contact Lenses that are prescribed solely for the purpose of correcting one of the following medical conditions, which prevent the Covered Person from achieving a specified level of visual acuity through the wearing of conventional eyeglasses: (1) Aphakia;
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Medically Necessary Contact Lenses section has been added to provide clarity regarding when medically necessary contact lenses are covered.  The “Eyeglasses and Contact Lenses after Cataract Surgery” section of the “Adult Vision Hardware and Optical Services Rider” and the “Pediatric Vision Hardware and Optical Services Rider” has been modified. The bullet describing coverage of contact lenses has been expanded to indicate that one conventional contact lens or up to a six-month supply of disposable contact lenses is covered for each eye, as industry standard has changed with the development of disposable contact lenses.  The “Adult Vision Hardware and Optical Services Rider Benefit Summary” has been modified to clarify that the allowance may be used toward prescription eyeglasses or conventional or disposable prescription contact lenses, including Medically Necessary contact lenses.
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Examples of Medically Necessary Contact Lenses in a sentence

  • Definitions Medically Necessary Contact Lenses: Contact lenses may be determined to be Medically Necessary and appropriate in the treatment of patients affected by certain conditions.

  • Additional Benefits Medically Necessary Contact Lenses are dispensed in lieu of other eyewear.

  • Medically Necessary Contact Lenses Medically Necessary Contact Lenses are subject to Authorization.

  • Medically Necessary Contact Lenses that are not duly Authorized will not be covered.

  • Lens Options (added to lens prices above) Tint (Solid and Gradient) Standard Plastic Scratch Coating Standard Polycarbonate No Copay No Copay No Copay $12 reimbursement $12 reimbursement $32 reimbursement Contact Lenses: covered once every Calendar Year – in lieu of spectacle lenses Elective Conventional Disposable Medically Necessary Contact Lenses – Preauthorization is required Note: Additional benefits over allowance are available from Participating Providers.

  • Lens Options (added to lens prices above): Tint (Solid and Gradient) Standard Plastic Scratch Coating Standard Polycarbonate No Copay No Copay No Copay $12 reimbursement $12 reimbursement $32 reimbursement Additional Benefits Medically Necessary Contact Lenses are dispensed in lieu of other eyewear.

  • No Copay No Copay No Copay No Copay $25 reimbursement $40 reimbursement $55 reimbursement $55 reimbursement Contact Lenses: covered once every Calendar Year – in lieu of spectacle lenses Elective Conventional Disposable Medically Necessary Contact Lenses – Prior Authorization is required Note: Additional benefits over allowance are available from Participating Providers.

  • Definitions Medically Necessary Contact Lenses: Contact lenses may be determined to be medically necessary and appropriate in the treatment of patients affected by certain conditions.

  • No Copay $25 reimbursement No Copay $35 reimbursement No Copay $45 reimbursement No Copay $45 reimbursement Contact Lenses: covered once every calendar year – in lieu of eyeglasses Elective Medically Necessary Contact Lenses – preauthorization is required Note: In some instances, Participating Providers may charge separately for the evaluation, fitting, or follow-up care relating to contact lenses.


More Definitions of Medically Necessary Contact Lenses

Medically Necessary Contact Lenses section has been added to the “Pediatric Vision Hardware and Optical Services Rider.” This section has been added to clarify existing benefits. The evaluation, fitting, and follow-up is covered for Medically Necessary contact lenses. Administrative changes or clarifications  The “Outpatient Prescription Drug Rider” has been modified. All references to the Catamaran pharmacy network option have been replaced with the MedImpact pharmacy network. Changes and clarifications that apply to dental plans Benefit clarifications  For Dental Choice PPO Plans, an “Emergency Dental Care and Urgent Dental Care” provision has been added to the “Benefit” EOC section. Administrative changes or clarifications  “Membership Services” in the Benefit Summary and the EOC has been replaced by “Member Services” to reflect the updated department name.  “Spouse” in the EOC “Definitions” section has been clarified as the person to whom you are legally married under applicable law.  The “Premium, Eligibility, and Enrollment” EOC section has been modified. We have added a new “Special Enrollment Due to a Section 125 Qualifying Event” provision that describes special enrollment information if Group has a Section 125 cafeteria plan.  The "Grievances, Claims, and Appeals" EOC section has been revised for more consistency with how we describe grievances, claims and appeals processes for our medical plans.  The “State Continuation Coverage for Surviving, Divorced, or Separated Spouses 55 or older in COBRA Groups” under the “Continuation of Membership” section has been deleted. This provision applies to medical plans only.  The “Litigation Venue” provision under the “Miscellaneous Provisions” section of the Group Agreement and EOC that specified Multnomah County as the litigation venue has been deleted. Oregon law confers to the courts the discretion to determine the litigation venue.
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Medically Necessary Contact Lenses section has been added to the “Pediatric Vision Hardware and Optical Services Rider.” This section has been added to clarify existing benefits. The evaluation, fitting, and follow-up is covered for Medically Necessary contact lenses. Administrative changes or clarifications The “Outpatient Prescription Drug Rider” has been modified. All references to the Catamaran pharmacy network option have been replaced with the MedImpact pharmacy network. Changes and clarifications that apply to dental plans Benefit clarifications For Dental Choice PPO Plans, an “Emergency Dental Care and Urgent Dental Care” provision has been added to the “Benefit” EOC section. Administrative changes or clarifications
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Medically Necessary Contact Lenses means Contact Lenses that are prescribed solely for the purpose of correcting one of the following medical conditions, which prevent the Covered Person from achieving a specified level of visual acuity through the wearing of conventional eyeglasses; (1) Aphakia; (2) visual acuity less than 20/70 in the better eye except though the use of Contact Lenses (must be 20/60 or better): (3) Anisometrophia of 4.0 diopters or more, provided visual acuity improves to 20/60 or better in the weak eye; or (4) Keratoconus. This benefit requires pre-authorization by Company.
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Medically Necessary Contact Lenses means: • Keratoconus where the Covered Person is not correctable to 20/30 in either or both eyes using standard spectacle lenses, or the Provider attests to the specified level of visual improvement; • High Ametropia exceeding -10D or +10D in spherical equivalent in either eye; • Anisometropia of 3D in spherical equivalent or more; or • Vision for a Covered Person can be corrected two lines of improvement on the visual acuity chart when compared to best corrected standard spectacle. Vision Examination – any eye or visual examination covered under the Policy and shown in the Schedule of Benefits. Vision Materials – those materials shown in the Schedule of Benefits.
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Related to Medically Necessary Contact Lenses

  • Medically Necessary means a service which is appropriate and consistent with the treatment of the condition in accordance with accepted standards of community practice.

  • Utilization management section means “you or your authorized representative.” Your representative will also receive all notices and benefit determinations.

  • Non-Administrator Dialysis Facility means a Dialysis Facility which does not have an agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan but has been certified in accordance with the guidelines established by Medicare.

  • Urgently Needed Services means Covered Services needed to prevent a serious deterioration in a Member’s health. While not as immediate as Emergency Services, these services cannot be delayed until the Member can see a Plan Provider.

  • Network Provider means a provider of health care, or a group of providers of health care, which has entered into a written agreement with the issuer to provide benefits insured under a Medicare Select policy.