AmeriHealth Caritas New Hampshire Vision Plan

Covered vision services

The plan covers the following services:

• Eye care services by an ophthalmologist, optometrist, or optician
• One refraction eye exam to determine the need for eyeglasses no more frequently than every 12 months
• Eye exams to diagnose and monitor medical conditions of the eye
• One pair of single vision lenses with frames, as follows:
• For members 21 years of age and older, if the refractive error is at least plus or minus .50 diopter, according to the refractive error which may be calculated as a combined total of the spherical and cylindrical errors, in both eyes
• For members younger than 21 years of age, if the refractive error is at least plus or minus .50 diopter, according to the refractive error which may be calculated as a combined total of the spherical and cylindrical errors, in at least one eye
• One pair of eyeglasses with bifocal corrective lenses (or one pair of eyeglasses with corrective lenses for close vision and one pair of eyeglasses with corrective lenses for distant vision) if there is a refractive error of at least .50 diopter for both close and distant vision
• Transition lenses for members with ocular albinism
• Contact lenses for ocular pathology in cases where the visual acuity is not correctable to 20/70 or better without contact lenses, or when required to correct aphakia or to treat corneal disease
• Replacement of the component eyeglasses parts due to breakage or damage, subject to all of the following:
• Replacements may be in the form of a single lens, both lenses, frame only, or a complete pair of corrective lenses.
• Each component part or complete pair of corrective lenses may only be replaced one time within a 12-month period.
• When the member has two pairs of eyeglasses in lieu of bifocals, each pair of eyeglasses is eligible for replacement.
• Only one replacement of lost eyeglasses per lifetime for members younger than age 21 years

The plan covers the following services:

• Trifocal lenses if the member:
• Is employed and the trifocal lenses are required for the work involved in the member’s employment; or
• Is a full-time student and the trifocal lenses are required for the work involved in the member’s education; or
• Currently has trifocals
• Replacement of nickel frames after 12 months, if the member has a documented allergy to nickel demonstrated by skin irritation and wearing down of the frame in the affected area
• Ocular prostheses, including artificial eyes and lenses.