Excludes: Radial keritotomy and related procedures designed to correct significantly refractive errors. Also excludes orthoptics which are eye exercises designed to correct eye problems.

Excludes: Eye glasses or contact lenses unless following cataract surgery. Also excludes diagnostic services that are not part of a vision exam, medical or surgical treatment, medications that are not needed for a visual exam, and unusual services, such as orthoptics. Vision training and low vision aids are also excluded.

With the purchase of a supplemental policy:

Covers: Routine eye examination by participating opthalmologist or optometrist. No referral is necessary. Also includes $50 hardware allowance for lenses, frames, or contacts.

Excludes: Some supplemental policies do not cover lenses, frames, or contacts.

Cost Sharing: Copayments may apply.

Excludes: Routine vision care, eyeglasses, contact lenses, (or the fitting of any of these) unless covered by a vision supplemental policy; refractic surgeries or procedures that lessen or eliminate the need for glasses or contact lenses.

Limits: Routine vision examinations limited to office visit with child’s PCP. Screenings may not be performed by an optometrist or ophthalmologist unless beneficiary purchases routine vision screening rider.

Excludes: Eyeglasses, contact lenses or their fitting (unless first pair following cataract surgery); vision therapy; services required by employer; surgery to correct refraction errors.

Cost Sharing: Copayments apply.

Excludes: Furnishing, fitting, or installation of eyeglasses and contact lenses unless covered by a rider. Also excludes vision therapy and radial keratotomy.

Excludes: Vision care, including: refraction; eyeglass frames; eye exercises; visual training; orthoptics; all types of contact or corrective lenses unless covered by a supplemental policy; treatment or diagnostic testing related to visual processing disorders.

Excludes: Routine vision examinations, eyeglasses, and corrective lenses. Also excludes radial keratotomy, surgeries to correct myopia, and eye exercises. Eye examinations needed to prescribe eyeglasses or contact lenses are also excluded, unless vision care was purchased through a supplemental policy.

With the purchase of a supplemental policy:

Covers: Medically necessary routine eye examinations.

Excludes: Drugs or other medication not used for the purpose of vision examination.

Limits: Routine eye examinations are covered for one exam per member per year. QualChoice has a maximum allowable benefit for eyeglasses or contact lenses following cataract surgery. The member must have a referral from the PCP.

With the purchase of a supplemental policy:

Covers: Eye surgery to correct myopia, hyperopia, astigmatism, or other surgical correction or visual impairment.

Excludes: Eye glasses, contact lenses, and other related appliances and supplies, unless purchased in a supplemental policy.

Cost Sharing: Copayment may apply.

Excludes: Eye glasses, contact lenses or fittings for eyewear, radial keratotomy and other refractive eye surgery, and related services to correct vision.

Cost Sharing: Copayment may apply.

Excludes: Eye exams to prescribe glasses or contact lenses; vision therapy unless purchased separately as a supplemental policy. Also excludes eyeglasses, contact lenses or their fitting, any other items or services for the correction of eyesight, orthoptics, vision training, and radial keratotomy or similar surgery for the treatment of myopia and keratoplasty.

With purchase of a supplemental policy:

Covers: One vision examination every 24 months by a participating optometrist, including refraction and glaucoma screening. Referral from PCP not required.