Vision benefits


Plan maximum: A plan maximum is the maximum amount that Moda Health will pay and is based on the plan coverage that the member chooses.

Plan allowable: The plan allowable is either the contracted rate that participating providers agree to accept as payment in full or the charges billed by nonparticipating providers. If a provider is contracted, he or she will be listed in the Moda Health online directory and agrees to accept discounted payment for services provided. The difference between the negotiated rate and the billed rate is a write off and cannot be billed to the member. If a provider is not participating and is not listed in our directory, he or she is not required to take any write-off and can balance bill the member for any amount not paid by Moda Health.

Are disposable contacts covered?

Disposable contacts are covered up to the plan maximums.

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How are providers reimbursed for vision services?

Contracted providers are reimbursed up to the plan allowable amount for covered services. Non-participating providers are reimbursed up to billed charges. Noncovered services are not covered under the contract, with no discount, and are the responsibility of the member. A list of noncovered services can be found under the Exclusions section of the Vision Member Handbook.

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Will the Moda Health vision plans pay for polycarbonate lenses for children and adults?

Yes. Moda Health will pay for polycarbonate lenses, up to the plan maximum.

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Are prescription sunglasses covered under this plan?

No. Prescription and nonprescription sunglasses or polarization are not covered on this plan and are the responsibility of the member.

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What is the coverage for frames and lenses under this plan?

One pair of lenses per plan year is covered for all ages. One pair of frames per plan year is covered for children under 17, and one pair of frames every two plan years is covered for adults age 17 and older.

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If I am double covered under two OEBB plans, can I get two pairs of glasses?

Typically members who are double covered will be subject to the same frequency limitations of those who are covered under one OEBB vision plan. However they will have a potential increased benefit maximum to use for covered vision services. Vision claims will be processed under the member's primary coverage and will automatically be processed under the secondary coverage if there is additional benefit to pay on the claim(s).

If the member does not want to coordinate their vision benefits on dual Moda OEBB plans, they can call in advance to request a vision claim not be processed under one of their plans.

If the member does not want to coordinate their benefits, Moda will process all vision claims (exam and hardware) on one plan one year and all vision claims (exam and hardware) on the other plan the next year. Members cannot request we process hardware on one plan and the exam on the other. If a member calls in the middle of their benefit period and we already have claims on file for that plan year, their request will not start until the next plan year.

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