Vision Services: Coverage And Limitations

Vision services are administered through a managed care contractor. (7-1-26) 01. Eye Examinations. One (1) eye examination is covered during any twelve (12) month period to determine the need for glasses to correct a refractive error. (7-1-26) 02. Eyeglasses and Contacts. Eyewear is covered when needed for correction of a refractive error. (7-1-26) a. Lenses will be covered once every four (4) years except when there is documentation of a major visual change. (7-1-26) i. Scratch resistant coating is required for all plastic and polycarbonate lenses. (7-1-26) ii. Tinted lenses are restricted to extreme medical conditions defined by the Department. (7-1-26) b. Contact lenses will be covered only for: (7-1-26) i. A need for correction equal to or greater than plus or minus ten (±10) diopters; or (7-1-26) ii. An extreme medical condition that does not allow correction using conventional lenses, such as cataract surgery, keratoconus, anisometropia, or other conditions defined by the Department. (7-1-26) c. One (1) set of frames is covered once every four (4) years except when receiving new lenses that do not fit in existing frames. (7-1-26) d. Fitting fees are covered only when the participant is eligible for the associated supplies. (7-1-26) 03. Vision Therapy. Vision therapy is covered for participants between the ages of nine (9) and twenty-one (21) with a diagnosis of convergence insufficiency. (7-1-26) 04. Non-Covered Items. Trifocal lenses, Progressive lenses, and photo gray. (7-1-26) 05. Participant Responsibility. Participants are responsible for replacement of broken, lost, or missing glasses. (7-1-26) 283. – 284. (RESERVED)