Vision benefits

Terminology

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 and plan allowable on Plans 1 through 4.

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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-particpating providers are reimbursed up to billed charges on Plans 1 through 4. 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 on Plans 1 through 4.

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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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