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VISION

VISION

Medical Mutual of Ohio partners with private practice eye care professionals and fulfillment locations to provide eye care services to enrolled participants.

Your plan provides a scheduled benefit which allows for pre-set limited expenses for examinations, corrective lenses and other hardware.

Your copays cover the Usual, Customary, and Reasonable Amount (UCR) per service. UCR is the amount paid for a vision service in a geographic area based on what providers in the area usually charge for the same or similar vision service. If you go to a provider that charges above UCR, you may be responsible for additional charges.  Please ask your vision provider if they are contracted in the Traditional Network with Medical Mutual.  When the provider is contracted with Medical Mutual, the payment will go to the provider.

  • When the member has services for a routine eye exam and the optometrist (or provider) is in network, the member’s plan will pay at 100% of the allowed amount, payable under the member’s Medical preventive benefit.  You will not pay the $7.50 copay for the eye exam only should you elect to use your eye care exam as an annual routine preventive examination run under your Medical plan.   The policy does have coverage for a vision exam and a physical exam under the Medical policy.  Both services have separate CPT Codes.  If for some reason the provider billed the vision exam as a physical, there would not be a benefit for that same CPT to be billed twice.
  • Should the member use an out of network provider, the member would then pay the $7.50 copay, processing under the member’s Traditional Vision plan. 
Overview of Coverage
Benefit Item
Copay
Vision Examinations
One per benefit period
$7.50
Basic Frames
One per two benefit periods
$12.50
Single Vision Lenses $12.50
Bifocal Lenses $12.50
Trifocal Lenses $12.50
Contacts in lieu of lenses
One per benefit period
$0
 
Premium Cost
Coverage Type
Vision
Single $0.39
Single + Spouse $0.96
Single + Child(ren) $0.96
Full Family $0.96
 
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