SECTION 11.2204. Minimum Standards - Vision Care Services and Benefits

(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.

Source Note: The provisions of this §11.2204 adopted to be effective August 1, 2017, 42 TexReg 2169