VISION PLAN OF AMERICA

Contact Lens Information

For All Plans

A - B - C

COSMETIC CONTACT LENSES -Available every 12 months for plans A and B; every 24 months for plan C.

Option1: Provide basic services (eye examination, refraction, eyeglass lenses and frame) and receive the co-payment (if any) for eye examination and any extras for the eye glasses. Members are eligible for contact lens services under the Schedule of Extras.

OR

If the member wishes Contact Lenses in lieu of Glasses

Option 2:Receive the co-payment (if any). Members are now eligible for a $100.00 credit towards the doctor’s usual and customary package fee, including exam (refraction), fitting and a supply of Contact Lenses. There are no benefits for only contact lens fitting or only contact lenses. The $100.00 credit only applies to the doctor’s usual and customary package fee (exam, fitting and lenses).

Ex: If your exam fee is $75.00, fitting fee is $125.00 and C.L. are $225.00, then the total =$425.00 less $100.00 credit; member pays $325.00.

* MEDICALLY NECESSARY CONTACT LENSES are available every 24 months. The Medically Necessary Contact lenses must correct the member’s acuity to 20/40 or better in the better eye.

A) Group ABC - This benefit includes a contact lens examination, fitting, follow up visits, and Medically Necessary lenses.  The Plan pays up to $250 towards this benefit.

B) Plan A or B Individual – This is a $250 benefit including a $75 co-payment.
* When visual acuity cannot be corrected to 20/70 or better by standard means (eyeglasses), medically necessary contact lenses may be indicated, as in (Keratoconus, Anisometropia or Cataract surgery).  Prior approval is necessary, please contact Vision Plan of America for the proper form or find the form in the “Provider Reference Guide” and return it to the Medical Director by mail or fax for approval.

Guidelines for Contact Lens Fitting

1. It appears under the new State Law ( Legislative Counsel’s Digest AB 2020) the provider must release contact lens prescription for soft contact lenses (exceptions: custom lens, specialty lenses, and RGP lenses).

2. Under the benefit plans offered by Vision Plan of America (Plans A, B, C), the contact lens benefit applies to the doctor’s annual package fee (examination, fitting, follow-up, and contact lenses). It is in the best interest of the patient to receive a complete eye examination as opposed to the fitting of new contact lenses from an old prescription or an eyeglass prescription.

3. The contact lens portion of the benefit was designed to allow the member to access care from the primary eye care provider and allow them the benefit contact lenses at a greatly reduced cost.

4. What happens if a member comes in with a valid prescription and wants to purchase contact lenses only?

The $100.00 applies only to the Doctor’s UCR package fee which includes exam, fitting, and contact lenses.