Vision Benefits

WellKids by PA Health and Wellness covers vision exams, corrective lenses, frames, or contacts in lieu of glasses or when medically necessary.

• Limited to one exam every 12 months unless an additional exam is medically necessary.
• Covers one pair of prescription eyeglass lenses and one frame, unless a second frame is medically necessary, or contacts every calendar year.
• Eyeglass lenses may be plastic or glass, single vision, bifocal or trifocal, lenticular lens powers and oversize lenses, fashion and gradient tinting, oversized glass grey #3 prescription sunglass lenses, or polycarbonate prescription lenses with scratch resistant coating.
• The allowance is $130 for prescription lenses and frames or contact lenses (including the lenses' fitting). Charges exceeding the $130 allowance are the responsibility of the Member. For any amount over $130, a 20 percent discount applies for contact lenses and frames.
• There may be copayments for optional lens types and treatments.

Replacement

Replacement of broken, lost, or scratched corrective lenses, frames, or medically necessary contacts (when replacement is deemed medically necessary), not to exceed two prescriptions per year.

Low Vision

Coverage includes one comprehensive low vision evaluation every five (5) years, with a maximum charge of $300; maximum low vision aid allowance of $600 with a lifetime maximum of $1,200 for items such as high-power spectacles, magnifiers and telescopes, and follow up care - four visits in any five-year period, with a maximum charge of $100 per visit. Providers will obtain the necessary preauthorization for these services.