Health Benefits provides coverage for eye exams and corrective eyewear to ensure clients maintain good eye health. Eye exams are important to check the eyes for common diseases and to evaluate the eyes as an indicator of overall health. Regardless of age or physical health, a comprehensive eye exam will help detect any eye problems early when they are most treatable.
The vision care benefit is administered through a partnership between Health Benefits and PBC. Clients can access detailed information about their vision care through the online PBC Member Profile.
Health Benefits covers specific vision care items and services under the following categories:
• Eyewear and Repairs; and• Tests and Exams.
• Eyewear and Repairs; and
• Tests and Exams.
Items and services not listed as a benefit may be covered on an exceptional basis. Clients should call Health Benefits at 1-855-550-5454 to learn more about exceptional coverage.
• Is the provider registered with PBC for billing?• Is the item or service fully covered by my plan?
Some vision care items and services are considered Exclusions under the vision care benefit. Clients cannot seek exception or appeal for Excluded items. Vision care benefit exclusions include, but are not limited to:
• Items that support the use of prescription eyewear (e.g., contact lens solution, glasses cases);• Industrial safety frames or lenses;• Non-prescription items;• Surgical procedures (e.g., laser eye surgery); and• Vision training.
• Items that support the use of prescription eyewear (e.g., contact lens solution, glasses cases);
• Industrial safety frames or lenses;
• Non-prescription items;
• Surgical procedures (e.g., laser eye surgery); and
• Vision training.
Vision care services must be provided by a licensed vision care professional such as an ophthalmologist, optometrist, or optician.
When coverage for a service has been denied, clients have the right to appeal the decision. Items and services that are Exclusions cannot be appealed. See the Appeals page for more information about the appeals process.
Information and forms for vision care providers can be found on the Information for Health Providers page.
For information on how to access vision care benefits check out the Vision Care Benefit Fact Sheet.
1-855-550-5454 (Toll Free)
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