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HealthPartners

Coverage criteria policies

Eyewear

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is not required for the purchase of eye glasses or contact lenses.

Coverage

Eyewear is generally covered subject to the indications listed below and per your plan documents.

Indications that are covered

  1. The initial evaluation, fitting and lenses for either eye glass lenses or contacts is covered when prescribed for the post-operative treatment of cataracts or for the treatment of Aphakia (absence of natural lens) or Kerataconus (cone shaped protrusion of the center of cornea). Coverage of the lenses is included in the office visit copay and is no longer covered under the DME benefit unless otherwise specified in the member contract or SPD.
  2. Contact lens, without correction, is the type of eyewear usually prescribed as a moist corneal bandage in the treatment of acute or chronic corneal pathology. For this condition, eyewear will generally be covered and dispensed during an office visit. Examples of conditions, which may require such eyewear as a corneal bandage, are:
    1. Corneal Ulcers
    2. Keratitis
    3. Bullous Keratopathy
    4. Other corneal disease

Indications that are not covered

  1. Eyeglasses or contact lenses beyond the initial pair for the treatment of cataracts, aphakia and / or keratoconus.
  2. Eyeglasses, contact lenses, and their fitting when not related to treatment of cataracts, aphakia and keratoconus.
  3. Eyewear options:
    1. Ultraviolet absorbing properties
    2. Scratch resistant coating (V2760) or protective coating for plastic lenses
    3. Sunglasses in addition to other lenses
    4. Anti-reflective coating (V2750)
    5. Edge treatment
    6. Fashion tints or polarized lenses
    7. Frames (Standard V2020, Deluxe V2025)
    8. Contact lens cleaning solution or normal saline for contact lenses
    9. Progressive lenses (V2781) or invisible bifocals
    10. Low vision aids (V2600, V2610, V2615)
    11. Oversize lenses (V2780)

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

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Policy activity

  • 01/01/1994 - Date of origin
  • 11/09/2017 - Effective date
Review date
  • 11/2017

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