Prior Authorization is required if more than one replacement is needed within the time periods noted above.Ī prescription change from a valid provider is required.īenefit coverage/limitations for spectacles are based on medical necessity- talk to your provider for more information.Īn Optometrist or Ophthalmologist can request prior authorization for alternative tint options based on medical necessity. Members 21 years and older: one replacement pair every 24 months without prior authorization Members under 21 years old: one replacement pair every 12 months without prior authorization Members 21 years and older: Requires Prior Authorization if repair is requested within 24 months of when glasses were dispensed. Glasses must be repaired or replaced by the optician who ordered the initial eyeglasses. Member 21 years and older: Once every 24 months With a prescription that meets certain criteria. Members who need bifocals may be able to get two pairs of glasses instead of bifocals, if certain criteria are met. Members 21 years and older: Once every 24 months Members younger than 21 years old: Once every 12 months Members may be covered for more frequent eye exams with a referral from a physician or if certain medical conditions exist. Members 21 years and older: Once every 24 months (No referral required)
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