dhcs.ca.gov/VisionBenefits

 

VISION

The following vision services are covered for
Medi-Cal Members:
 Medically Necessary eye examinations for
Diagnosis, treatment or prevention of eye
disease or detection of ophthalmologic
complications of medical disease.

 Routine eye examination (refraction) every two
years. Members may self-refer to obtain routine
vision services from a participating optical
Provider. Members may contact Member
Services at 1-800-675-6110 to obtain a
directory of participating optometrists and
ophthalmologists.
 Eye examination every year by an
ophthalmologist or optometrist for Members
with diabetes or other Chronic medical
problems affecting the eye
 Medical eye exams by an ophthalmologist or
optometrist for Acute or Urgent Care
 Contact lenses when Medically Necessary are
covered for Eligible Medi-Cal Members 20 and
under or Members residing in Skilled Nursing
Facilities (SNFs). Adults 21 and over are
covered for bandage contacts only when
Medically Necessary; other ophthalmological
materials are not covered.
Optical lenses and frames (every two years) for
Members under age 21, pregnant women if your
doctor says not having them will be harmful to
your baby or pregnancy, and people living in a
nursing home. Optical lenses are made by the
California Prison Industry Authority (CALPIA)
optical laboratories unless you are being seen by
an Authorized Mobile Vision Service provider
(LA County only); however, our plan or the
delegated participating Medical Group, as
applicable, will arrange for this service.

Optical lenses and frames for Members age 21 and
over are not a covered benefit   Health Net Evidence of Coverage Page 30

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