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 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.

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;

Examples of Medically Necessary Contact Lenses in a sentence

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

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

• 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.

• Medically Necessary Contact Lenses – Contact lenses are defined as medically necessary if the individual is diagnosed with one of the following specific conditions: Network (In-Network) – The doctors, clinics, health centers, medical group practices, facilities and other professional provides that a managed care organization has selected and contracted with to provide health care for its members.

• 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.

• Reimbursement up to $70 Elective Contact Lenses $175 allowance (in lieu of frame & lenses) Reimbursement up to $105 (in lieu of frame & lenses) Medically Necessary Contact Lenses $10 copay* Reimbursement up to $210 Frequency of exam benefit Every calendar year Every calendar year Frequency of frame and lens benefit Every calendar year Every calendar year * $10 exam copays.

• No Copay $25 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.

• Dependent Age Limit Age 19/Age 26 if full time student Examination (One Every 12 Months) 100% UCR Frames (One Pair Every 12 Months) Limited to $140 Lenses These benefits are paid per person for 12 months Single $70/pair Bifocals $100/pair Trifocals $140/pair Lenticular $150/pair Medically Necessary Contact Lenses $300/pair Cosmetic Contact Lenses $140/pair Good attendance is essential to efficient and smooth operation of the Central Ohio Transit Authority.

• Ophthalmic Lenses, Ophthalmic Frames, Contact Lenses and Medically Necessary Contact Lenses (where indicated and upon approval).

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

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

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.

Medically Necessary Contact Lenses means: 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.

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.