PEDIATRIC VISION CARE BENEFITS. Pediatric Vision Care is made part of and is in addition to any information You may have in Your HMO Certificate. Information about coverage for the routine vision care services are outlined below and are specifically excluded under Your medical health care plan. (Services that are covered under Your medical plan are not covered under this Pediatric Vision Care Benefit.) All provisions in the Certificate apply to Pediatric Vision Care Benefits unless specifically indicated otherwise below. 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. 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, irregular astigmatism. Provider – For purposes of this Pediatric Vision Care Benefit, a licensed optometrist, ophthalmologist or therapeutic optometrist operating within the scope of his or her license, or a dispensing optician. Vision Materials – Corrective lenses and/or frames or contact lenses.
PEDIATRIC VISION CARE BENEFITS. Your coverage includes benefits for pediatric vision care. This section of your Certificate explains what those benefits are.
