Page 62 - Appendices for Eric Hartman
P. 62
VISION
Routine eye exam $0 copay Limits apply
Contact lenses $0 copay Limits apply
Eyeglasses (frames & $0 copay Limits apply
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 Some coverage
