Medically Necessary Contact Lenses
The Plan provides coverage for medically necessary contact lenses when one of the following conditions exists:
- Anisometropia of 3D in meridian powers
- High Ametropia exceeding — 10D or +10D in meridian powers
- Keratoconus mild/moderate — when keratoconus is present and the member's vision is not correctable to 20/25 in either or both eyes using standard spectacle lenses
- Keratoconus advanced/ectasia — when keratoconus is present and one or more specified conditions are met
- Vision Improvement: when the member's best correctable distance vision using a standard visual acuity chart can be improved by at least two lines by the use of contact lenses compared to spectacle lenses
The benefit may not be expanded for other eye conditions even if you or your providers determine that contact lenses are necessary for other eye conditions or visual improvement.