Pediatric Vision

Pediatric Vision Services

(for Members under age 19 only)

Comprehensive Vision Exam

(Limited to 1 each calendar year)

Prescription Glasses

Frames

• Limited to 1 pair of frames every calendar year
• Limited to a selection of covered frames

Lenses

• Limited to 1 pair every calendar year
• Single vision, lined bifocal, lined trifocal, lenticular lenses, polycarbonate lenses
• All lenses include scratch resistant coating and ultraviolet protection (UV)

Prescription Contact Lenses

In lieu of prescription glasses, prescription contact lenses covered with a minimum 3-month supply for any of the following modalities every calendar year:

• Standard (one pair annually)
• Monthly (six-month supply)
• Bi-weekly (three-month supply)
• Dailies (three-month supply)

Medically necessary contact lenses for specified medical conditions require Prior Authorization.

Low Vision Optical Devices and Services

(Subject to limitations. Prior Authorization applies.)

Vision benefits included for children through age 18. Click here to find a list of eye doctors or call Vision Service Plan (VSP) at (844) 292-4903.

Please click here to see the pediatric eye glass frame collection under your coverage.