the free phone-based program, “Talk with a Health Consultant,” call 503-286-6816 or 1-866-301-3866 (toll free) and select option 2. 39. Vasectomy Services Male sterilization procedures such as vasectomy are covered. 40. Vision Services for Adults Routine eye examinations, including refractions, when provided by an optometrist Participating Provider. Prescription eyeglass lenses and a frame, or prescription contact lenses, including Medically Necessary contact lenses are covered when obtained at a Participating Facility optical center. Vision Services covered under this “Vision Services for Adults” section are only for Members age 19 and older. If a Participating Provider determines that one or both of your eyes has had a change in prescription of at least .50 diopters within 12 months after the date of your last exam where this benefit was used, we will provide an allowance toward the price of a replacement eyeglass lens or contact lens for each qualifying eye at the following maximum values: $60 for single vision eyeglass lenses $60 for single vision cosmetic contact lenses $90 for multifocal eyeglass lenses $90 for multifocal cosmetic contact lenses This replacement lens allowance is the same total amount whether you replace one lens or two. The replacement lenses must be the same type as the lenses you are replacing (eyeglass lenses or contact lenses). Medically Necessary Contact Lenses Contact lenses may be determined to be Medically Necessary and appropriate in the treatment of the following conditions: Keratoconus. Pathological myopia. Aphakia. Anisometropia. Aniseikonia. Aniridia. Corneal disorders. Post-traumatic disorders. Irregular astigmatism. The evaluation, fitting, and follow-up is covered for Medically Necessary contact lenses. Medically Necessary contact lenses are subject to Utilization Review by Kaiser using criteria developed by Medical Group and approved by Kaiser. Eyeglasses and Contact Lenses after Cataract Surgery If you have cataract surgery and since that surgery we have never covered eyeglasses or contact lenses under any benefit for eyeglasses and contact lenses after cataract surgery (including any eyeglasses or contact lenses we covered under any other coverage), we cover your choice of one of the following without charge, if EWCLGHDHP1983ACT0124 71 WAPEBB-CD-ACT
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