|
 Regular eye exams are important. Call your eye doctor to schedule a routine eye exam. If you need help finding an eye doctor, search the Provider Directory or call Member Services. If you need specialty eye care (for example, treatment of accidental injury or trauma to the eyes or treatment of disease to the eyes), you must go to your PCP first. Your PCP will refer you to a specialist.
Eye Care Benefits for Children (Younger Than 21 Years of Age)
Members are eligible for routine eye examinations every calendar year, or more often if medically necessary. No referral is needed for routine eye exams.
Members are also eligible to receive two pairs of prescription eyeglasses every 12 months, or more often, if medically necessary. Members may choose prescription contact lenses instead of glasses. If the prescription eyeglasses are lost, stolen or broken, AmeriHealth Mercy will pay for them to be replaced.
Members may choose from a special group of Davis eyeglass frames at no charge, or:
- A member may choose a Designer frame from Davis’ “Tower Collection” and the AmeriHealth Mercy Provider will collect from the member a $15.00 co-pay.
- A member may choose a Premier frame from Davis’ “Tower Collection” and the AmeriHealth Mercy Provider will collect from the member a $35.00 co-pay.
Members may choose eyeglass frames that are not part of these special groups and AmeriHealth Mercy will pay for the cost of the frames or $30.00, whichever is less. Members may choose prescription contact lenses instead of glasses, and AmeriHealth Mercy will pay for the cost of the prescription contact lenses or 60.00, whichever is less. Lost, stolen or broken prescription contact lenses will be replaced with prescription eyeglasses.
There are special provisions for members with aphakia or cataracts. Please call Member Services for more information. Members may choose a special lens type for an additional co-payment.
Eye Care Benefits for Adults (21 Years of Age and Older)
Members are eligible for routine eye exams every calendar year. No referral is needed for routine eye exams.
Members may receive additional eye exams (up to three additional exams per calendar year) if the eye doctor completes a form.
Members are also eligible to receive prescription eyeglasses once every 12 months. Members may choose prescription contact lenses instead of glasses.
Members may choose from a special group of Davis eyeglass frames at no charge, or:
- A member may choose a Designer frame from Davis’ “Tower Collection” and the AmeriHealth Mercy Provider will collect from the member a $15.00 co-pay.
- A member may choose a Premier frame from Davis’ “Tower Collection” and the AmeriHealth Mercy Provider will collect from the member a $35.00 co-pay.
 Members may choose eyeglass frames that are not part of these special groups and AmeriHealth Mercy will pay for the cost of the frames you select of $30.00, whichever is less. Members may choose prescription contact lenses instead of glasses, and AmeriHealth Mercy will pay a portion of the cost, up to $60.00.
There are special provisions for members with aphakia or cataracts. Call Member Services for more information.
Members may choose a special lens type for an additional co-payment. There may be co-pays for some Optometry (eye care) services. Please see the Member Co-payment Schedule for more information.
|
Community 
