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Mercy Health Plan, Philadelphia, PA, A Managed Healthcare Organization, Serving
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| Home > Members > Health & Wellness > Eye Care |
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Eye Care
Regular eye exams are important. Call your eye doctor to schedule a routine eye exam. If you need help finding an eye doctor, go to the Provider Directory, or call Member Services. If you need specialty eye care (for example, treatment of accidental injury or trauma to the eyes or treatment of disease to the eyes), you must go to your PCP first. Your PCP will refer you to a specialist.
Eye Care Benefits for Children (younger than 21 years of age)
Members are eligible for routine eye examinations every calendar year, or more often if medically necessary. No referral is needed for routine eye exams. Members are also eligible to receive two pairs of prescription eyeglasses, every 12 months, or more often if medically necessary. Members may choose prescription contact lenses instead of glasses.
If the prescription eyeglasses are lost, stolen or broken, Keystone Mercy will pay for them to be replaced. Lost, stolen or broken prescription contact lenses will be replaced with prescription eyeglasses.
- Members may choose from two select groups of Davis eyeglass frames at no charge;
or
- They may choose from a select group of Davis premier eyeglass frames for a co-payment of $25.00;
or
- They may choose eyeglass frames that are not part of these select groups and Keystone Mercy will pay for the cost of the frames or $40.00, which ever is less.
For members that choose prescription contact lenses instead of glasses, Keystone Mercy will pay for the cost of the prescription contact lenses or $75.00, whichever is less. There are special provisions for members with aphakia or cataracts. Please call Member Services for more information.
Eye Care Benefits for Adults (21 years of age and older)
Members are eligible for routine eye exams every calendar year. No referral is needed for routine eye exams. Members may receive additional eye exams (up to three additional exams per calendar year) if the eye doctor completes a form. Keystone Mercy does not cover prescription eyeglasses or prescription contact lenses for members 21 years of age and older. There are special provisions for members with aphakia or cataracts. Call Member Services for more information. There may be co-pays for some Optometry (eye care) services. Please see the “Member Co-payment Schedule” for more information.
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