Page 74 - Appendices for Barbara Pender
P. 74

VISION




       Routine eye exam                       $0 copay                               Limits apply





       Contact lenses                         $0 copay                               Limits apply




       Eyeglasses (frames &                   Not covered
       lenses)





       Eyeglass frames only                   $0 copay                               Limits apply




       Eyeglass lenses only                   $0 copay                               Limits apply








       Upgrades                               Not covered




   MEDICALLY-APPROVED NON-OPIOID PAIN MANAGEMENT SERVICES



       Chiropractic services                                      Some coverage





       Acupuncture                                                Some coverage




       Massage therapy                                            Not covered





       Alternative therapies                                      Not covered
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