Children (ages 0-20) may receive one eye exam for the purpose of obtaining eyeglasses each state fiscal year (Sept. 1 through Aug. 31). This limit of one exam within that 12-month period can be expanded in three situations:
- teacher or school nurse requests eye exam;
- diopter change of .5 or more;
- additional eye exam is medically necessary.
Adults (age 21 or over) are eligible for one examination with refraction for the purpose of obtaining eyewear every 24 months.
For children, there are no limitations on the number of replacements for lost or destroyed eyewear. This includes necessary major repairs to damaged eyeglasses. Any diagnosed conditions or abnormalities of the eye that require treatment or additional services beyond the scope of an exam for refractive errors must be referred back to the Member’s Primary Care Provider. Vision care Providers who furnish additional services must have Primary Care Provider authorization.