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Eye

Keystone First – CHIP covers all medically necessary vision services. Your child may go to a participating vision provider within the Keystone First – CHIP network.

Eye Examinations

  • All routine eye examinations must be performed by a participating provider. There is no coverage when performed by a nonparticipating provider.*
  • A routine eye examination and refraction, including dilation if professionally indicated, is covered 100%, once (1) every calendar year.

Frames and Prescription Lenses

  • One (1) pair of frames every calendar year at no additional cost, when purchased from a participating provider and selected from the standard collection of frames.
  • For frames that are not part of the standard collection of frames, expenses over $130 are your responsibility. Additionally, a 20% discount applies to any amount over $130.
  • One (1) set of prescription eyeglass lenses every calendar year that may be plastic or glass*, single vision, bifocal, trifocal, lenticular and/or oversize lenses, fashion and gradient tinting, oversized glass-grey #3 prescription sunglass lenses, and polycarbonate prescription lenses.
  • All prescription lenses include scratch-resistant coating.
  • There is no copayment for covered standard prescription eyeglass lenses. However, most optional lens types and treatments have applicable copayments.
  • Replacement of lost, stolen, or broken frames and prescription lenses, when deemed medically necessary, once every calendar year.*

 Prescription Contact Lenses

  • One (1) prescription contact lens benefit every calendar year, in place of eyeglasses or when medically necessary, must be purchased from a participating provider.
  • Expenses over $130, which may be applied toward the cost of evaluation, materials, fitting and follow-up care, are the Enrollee’s responsibility. Additionally, a 15% discount applies to any amount over $130.
  • In some instances, participating providers charge separately for the evaluation, fitting, or follow-up care related to contact lenses. Should this occur, and the value of the prescription contact lenses received is less than the allowance, the remaining balance can be applied to the total $130 allowance.
  • Expenses in excess of $600 for medically necessary prescription contact lenses, and with preapproval, may be obtained for conditions including:
    • aphakia;
    • pseudophakia;
    • keratoconus;
    • if the patient has had cataract surgery or implant, or corneal transplant surgery; or if visual activity is not correctable to 20/40 in the worse eye by use of eyeglass lenses, but can be to 20/40 in the worse eye by use of contact lenses.
  • Replacement of lost, stolen, or broken prescription contact lenses, when deemed medically necessary, once every calendar year.*

Low Vision Benefits

  • One (1) comprehensive low vision evaluation every five (5) years, with a maximum charge of $300; maximum low vision aid allowance of $600, with a lifetime maximum of $1,200 for items such as high-power spectacles, magnifiers and telescopes; and follow-up care — four (4) visits in any five (5)-year period, with a maximum charge of $100 per visit. Providers will obtain the necessary preauthorization for these services.

Please review the Enrollee handbook for more information on vision coverage.

* A participating provider must be used for these services.