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Vision Benefits

How does the Essence Vision Care benefit work?

Do I have to go to specific providers?

Yes, to use your Essence vision benefits you must use a “Routine Vision Care Provider” listed as such in the Essence Provider Directory for routine eye exams (no eye related problems) or to obtain eyeglasses or contact lenses.

If you have eye problems (i.e., cataracts, glaucoma, need eye surgery, etc.), you must obtain a referral from your Primary Care Physician to see either an Ophthalmologist or Optometrist, listed as such in the Essence Provider Directory.

If you need glasses or contact lenses for any reason they must be purchased from a “Routine Vision Care Provider” to be covered by Essence.

When do I go to a Routine Vision Care Provider?

For a routine eye exam (no eye related problems) or to purchase eye glasses or contact lenses.

Do I need a referral for routine vision care?

No, you may go to a “Routine Vision Care Provider” for a routine eye exam (no eye related problems) without a referral from your Primary Care Physician.

If I have a medical eye condition do I need a referral?

Yes, you must obtain a referral from your Primary Care Physician to see an Essence Ophthalmologist or Optometrist.

Can I purchase my glasses or contact lenses from any Essence Provider in the Essence Provider Directory?

No, you must visit one of the “Routine Vision Care Providers” listed as such in the Essence Provider Directory. If you purchase your glasses or contact lenses from an Essence provider that is not listed specifically in the “Routine Vision Care Provider” section they will not be covered under your Essence vision benefits.

Consult your Evidence of Coverage for applicable coverage limits.

Important information regarding Eye Refractions

Eye Refractions are the tests used to determine the prescription for eyeglasses or contact lenses. Traditional Medicare does not cover eye refractions. However, Essence does when provided by a Routine Vision Care Provider. Eye refractions are not covered by Essence when provided by a specialist as part of medical treatment for an eye condition. If you receive medical treatment for an eye condition and the specialist wants you to have eye refraction, you may have to pay one co-pay to your specialist for medical treatment and another co-pay to the Routine Vision Care Provider for another eye exam and refraction. If you have questions regarding how the eye refraction coverage works, please contact Customer Service.

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