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 Services means those covered services that are, under the terms and conditions of the contract, determined through contractor utilization management to be:

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

  • Primary Contact means the individual a Proponent (that has submitted a Proposal), designates to represent the Proponent during the competitive process associated with this RFP. There can be only one (1) Primary Contact.

  • Medically Necessary Treatment means any treatment, tests, medication, or stay in hospital or part of a stay in hospital which:

  • Emergency Contact means one person or office that can act as a referral if emergency responders need assistance in responding to a chemical release at the facility.

  • Medical physicist means a person trained in evaluating the performance of mammography equipment and facility quality assurance programs and who meets the qualifications for a medical physicist set forth in 41.6(3)“c.”

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

  • Key Management Personnel means persons having authority and responsibility for planning, directing and controlling the activities of the Company, directly or indirectly, including any Director (whether executive or otherwise) of the Company;

  • Family child care provider means a person who: (a) Provides

  • 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.

  • Medically fragile means the condition of a child who requires the availability of twenty-four-hour skilled care from a health care professional or specially trained staff or volunteers in a group care setting. These conditions may be present all the time or frequently occurring. If the technology, support and services being received by the medically fragile children are interrupted or denied, the child may, without immediate health care intervention, experience death.

  • Baseline Personnel Security Standard means the pre-employment controls for all civil servants, members of the Armed Forces, temporary staff and government contractors generally.

  • Appraisal management services means one or more of the following:

  • Home health aide services means the personal care and maintenance activities provided to individuals for the purpose of promoting normal standards of health and hygiene.

  • Primary care physician means a physician qualified to be an attending physician according to ORS 656.005(12)(b)(A) and who is a general practitioner, family practitioner, or internal medicine practitioner.

  • Assisted outpatient treatment or "AOT" means the categories of outpatient services ordered by the court under section 468 or 469a. Assisted outpatient treatment may include a case management plan and case management services to provide care coordination under the supervision of a psychiatrist and developed in accordance with person-centered planning under section 712. Assisted outpatient treatment may also include 1 or more of the following categories of services: medication; periodic blood tests or urinalysis to determine compliance with prescribed medications; individual or group therapy; day or partial day programming activities; vocational, educational, or self-help training or activities; assertive community treatment team services; alcohol or substance use disorder treatment and counseling and periodic tests for the presence of alcohol or illegal drugs for an individual with a history of alcohol abuse or substance use disorder; supervision of living arrangements; and any other services within a local or unified services plan developed under this act that are prescribed to treat the individual's mental illness and to assist the individual in living and functioning in the community or to attempt to prevent a relapse or deterioration that may reasonably be predicted to result in suicide, the need for hospitalization, or serious violent behavior. The medical review and direction included in an assisted outpatient treatment plan shall be provided under the supervision of a psychiatrist.

  • 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.

  • Case management services means planned referral, linkage, monitoring and support, and advocacy provided in partnership with a consumer to assist that consumer with self sufficiency and community tenure and take place in the individual’s home, in the community, or in the facility, in accordance with a service plan developed with and approved by the consumer and qualified staff.

  • Dependent care assistance program or "DCAP" means a benefit plan whereby school employees may pay for certain employment related dependent care with pretax dollars as provided in the salary reduction plan under chapter 41.05 RCW pursuant to 26 U.S.C. Sec. 129 or other sections of the Internal Revenue Code.

  • Secondary containment or “secondarily contained” means a release prevention and release detection system for a tank or piping. This system has an inner and outer barrier with an interstitial space that is monitored for leaks. This term includes containment sumps when used for interstitial monitoring of piping.

  • Change Management means the add-on module to the Programs that enables engineers to define network changes through one or more configuration templates. Those network changes can be applied to multiple devices and executed/rolled back automatically. The Change Management module enables engineers to verify the impact of the changes across the network to help ensure a safer change process.