Vision Care Coverage
Your coverage includes:
- For each adult member (including unmarried children age 21 to 25 who are full-time students): 100% of eligible eye care expenses, to a maximum of $150 per person every two years, following the actual purchase date of the first claim.
- For dependant children up to the age of 21: 100% of eligible eye care expenses, to a maximum of $150 per person per year, following the actual purchase date of the first claim.
- Reimbursement for contact lenses is subject to the vision maximum, unless an ophthalmologist or optometrist certifies that contact lenses are required as a result of an eye disorder, and that the necessary correction cannot be achieved with ordinary lenses. In this event, reimbursement is limited to $200 every two years.
Eligible eye care expenses include costs for the following:
- Eyeglasses (frames and/or lenses), replacement glasses and contact lenses when prescribed by a physician, ophthalmologist or optometrist.
- Repairs to existing glasses.
- For each adult member (including unmarried children age 21 to 25 who are full-time students): One eye examination in a two-year period when rendered by a physician, ophthalmologist or optometrist.
- For dependant children up to the age of 21: One eye examination in a one-year period when rendered by a physician, ophthalmologist or optometrist.
- Laser eye surgery, including costs for foldable lens implants when performed by an ophthalmologist or physician.
Exclusions and Limitations
Eye care expenses are limited to Reasonable and Customary charges or expenses, which is the amount usually charged for specific medical procedures or services in the area where the procedures or services are provided.
The Healthcare Plan will not pay for the following:
- Expenses for fitting eyeglasses.
- Orthoptics, vision training, subnormal vision aids and aniseikonic lenses.
- Non-corrective sunglasses, photo sensitive or anti-reflective lenses or clip-ons.
- Lenses that do not require a prescription from a physician, ophthalmologist or optometrist.
See also General Exclusions section.
