per 30-days up to a 90-day supply Optical (vision) Routine eye examinations and refractions, limited to once Routine Exams: After Deductible, Enrollee pays every 12 months. 10% Plan Coinsurance Eye and contact lens examinations for eye pathology and to Exams for Eye Pathology: After Deductible, monitor Medical Conditions, as often as Medically Enrollee pays 10% Plan Coinsurance Necessary. Enrollees age 19 and over: Frames and Lenses: No charge; Enrollee pays Eyeglass frames, lenses (any type), lens options such as nothing, limited to an Allowance of $150 every 24 tinting, or prescription contact lenses, contact lens evaluations months and examinations associated with their fitting. The benefit period begins on the date services are first obtained. The After Allowance: Allowance may be used toward the following in any Not covered; Enrollee pays 100% of all charges combination: • Eyeglass frames Note: This benefit is separate from the benefits of • Eyeglass lenses (any type) including tinting and the Health Savings Account (HSA) Qualified Health coating Plan and not subject to the annual Deductible • Corrective industrial (safety) lenses • Sunglass lenses and frames when prescribed by an eye care provider for eye protection or light sensitivity • Corrective contact lenses in the absence of eye pathology, including associated fitting and evaluation examinations • Replacement frames, for any reason, including loss or breakage • Replacement contact lenses • Replacement eyeglass lenses Contact Lenses or Framed Lenses for Eye Pathology: After Deductible, Enrollee pays 10% Contact lenses or framed lenses for eye pathology when Plan Coinsurance Medically Necessary. One contact lens per diseased eye in lieu of an intraocular lens is covered following cataract surgery provided the Enrollee has been continuously covered by KFHPWA since such surgery. In the event an Enrollee’s age or medical condition prevents the Enrollee from having an intraocular lens or contact lens, framed lenses are available. Replacement of lenses for eye pathology, including following cataract surgery, is covered only once within a 12-month period and only when needed due to a change in the Enrollee’s prescription. Replacement for loss or breakage is subject to the frames and lenses benefit. Enrollees to age 19: Eyeglass frames, lenses (any type), lens options such as Frames and Lenses (in lieu of contact lenses): No tinting, or prescription contact lenses, contact lens evaluations charge; Enrollee pays nothing for 1 set of frames and and examinations associated with their fitting. The benefit lenses per calendar year period begins on January 1 and continues through the end of PEBB HMOHSA 2024 34