Eye Exams

• Eye examinations are covered every 24 months for persons aged 19-64

• Persons under 19, 65 or over, or with a medical condition, may be eligible for more frequent examinations

Note: The program pays a maximum of $100.00 for eye exams for
persons between the age of 19 and 64. Many providers will ask you to pay an additional amount.

Eyewear

For clients 18 and younger

• $275 every year for standard eyewear

For clients 19 and older

• $275 every two years for standard eyewear

Eyeglasses Replacement

• To qualify for replacement eyeglasses there must be a change in your prescription of .5 (half) of a diopter or more

• To qualify for high index (thinner) lenses there must be a change of 7.00 diopters or more

• Lenses may be changed every 12 months for persons 17 and under

• Lenses may be changed every 24 months for persons 18 years and older

• Lenses may also be changed if there is a physical need or change

Contact Lenses

• Eligibility for contact lenses is evaluated on a case by case basis

Exclusions

Examples of vision care items and services that are not covered include:

• Items that support the use of prescription eyewear
• Industrial safety frames or lenses
• Non-prescription items
• Surgical procedures (e.g., laser eye surgery)
• Vision training

Contact

Pacific Blue Cross at 1-855-550-5454