Each routine eye examination shall be a complete analysis of the member's visual functions and shall include the following components:

• Medical history
• Visual acuities with correction for distance and near (if applicable)
• External examination of the eye and adnexa
• Determination of neurological integrity including test of pupillary response
• Slit-lamp examination with tension
• Dilated fundus examination as per OptiCare's dilation protocol
• Tonometry
• Summary, diagnosis and treatment plan including prescribing of corrective lenses.

OptiCare covers standard necessary lenses in full: including single vision, bifocal, trifocal, and lenticular.  Standard lenses are typically composed of plastic materials.

There are several lens features that are available for cosmetic or comfort reasons. Depending on your benefit plan, lens features such as no-line bifocals (progressive lenses), anti-reflective coating, hi-index, or tints may be covered or may be available at a reduced cost. OptiCare has established Member maximum payment amounts for the most popular lens features. All Member maximum payments are for a "pair" of lenses and can be found on the My Benefits page.

Some plans offer formulary progressive options.  This means that a Member may further reduce out-of-pocket expenses for progressive lenses by selecting a lens from our Preferred Formulary table shown below.  Lenses selected from this list are covered at no additional cost.  Charges for additional lens features (Tint, UV Coating, etc.) may apply.  Please ask your eye care provider if one of the progressive lenses shown below or like product is right for you.

For plans that do not have a formulary progressive option, the Member out-of-pocket expense for progressive lenses is the same as it is for non-formulary options.

You may choose any frame in your provider's office. If the retail value of the frame is less than your frame allowance, you have no out-of-pocket expense for the frame. If the retail value of the frame exceeds your allowance, you will be responsible for the amount over the allowance less a 20% discount.

In lieu of spectacles, benefits may be used for the fitting, follow-up and/or purchase of contact lenses. As an OptiCare Member, you will receive an additional 20% for amounts exceeding the contact lens allowance.

When the Standard Contact Lens Fitting Fee indicates "Included in Allowance", charges for the fitting fee are part of the allowance and will be accumulated towards the total allowance amount.

When the Standard Contact Lens Fitting Fee indicates "Covered", a standard contact lens fitting exam is covered separately at no cost when using an in-network provider. Members receiving a non-standard contact lens fitting exam are responsible for 80% of U&C costs, less $75.00. Definitions for standard and non-standard are as follows.

Standard contact lens fitting exams are typically performed for current wearers of conventional or disposable lenses.

Non-standard contact lens fitting exams are typically performed for new wearers of contact lenses or for wearers of toric, RGP, or multi-focal lenses.

Medically necessary contacts are covered in full when using an in-network Provider and are limited to certain conditions. Providers must submit a "Statement of Medical Necessity" when filing claims for medically necessary contact lenses. Certain conditions automatically meet medical necessity such as: keratoconus, aphakia, or certain types of anisometropia. Medically necessary contact lenses are in lieu of glasses or elective contact lenses.

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• 1st Pair Discounts 20% off usual and customary hardware fees over and above plan allowance on first pair of eyeglasses and contacts.
  
  
• 2nd Pair Discounts 30% off frames & lenses, 25% off sunglasses, 20% off contact lenses for additional pairs of eyeglasses and contacts.

• No benefits will be paid for services or materials connected with or charges arising from vision training, subnormal vision aids, and any associated supplemental testing.
• Medical and/or surgical treatment of the eye(s) or supporting structures.
• Any eye or Vision Examination, or any corrective eye wear, required by an employer as a condition of employment
• Services provided as a result of Worker's Compensation law, or similar legislation, or required by any governmental agency or program whether Federal state or subdivisions thereof.
• Plano (non-prescription) lenses, non-prescription sunglasses, or two pair of glasses in lieu of bifocals.
• Lost or broken lenses, frames, glasses or contacts lenses will not be replaced except in the next benefit period when vision materials next become available.
• Vision Exam and Vision Materials - Fees charged by a provider for services other than a vision exam or covered vision materials must be paid in full by the Covered Person to the provider.  Such fees or materials are not covered under this plan.