| (a) Each single service HMO evidence of coverage providing
vision care services and benefits must provide the following as covered
primary and preventive vision services:
(1) comprehensive eye examination to include medical
history;
(2) visual acuities, with and without correction (distance
and near);
(3) cover test at 20 feet and at 16 inches;
(4) versions;
(5) external examination of the eye lids, cornea, conjunctiva,
pupillary reaction (neurological integrity), and muscle function;
(6) binocular measurements for far and near;
(7) internal eye examination (ophthalmoscopy);
(8) autorefraction/refraction (far point and near point);
(9) tonometry (reasonable attempt or equivalent testing
if contraindicated);
(10) retinoscopy;
(11) biomicroscopy;
(12) intraocular pressure glaucoma test;
(13) slit lamp examination; and
(14) urgent care.
(b) A single service HMO evidence of coverage providing
vision care services and benefits may provide coverage for secondary
vision care services, which include:
(1) contact lens examination;
(2) fitting;
(3) training;
(4) follow-up visits; or
(5) eye glasses.
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