Page 50 - APPENDICES for Diane Falten
P. 50
VISION
Routine eye exam In-network: $0 copay Limits apply
Contact lenses In-network: $0 copay
Eyeglasses (frames & In-network: $0 copay
lenses)
Eyeglass frames only In-network: $0 copay
Eyeglass lenses only In-network: $0 copay
Upgrades In-network: $0 copay
MEDICALLY-APPROVED NON-OPIOID PAIN MANAGEMENT SERVICES
Chiropractic services Not covered
Acupuncture Some coverage
Massage therapy Not covered
Alternative therapies Some coverage
