For information regarding the effective dates of Policies, contact your provider representative. In some states, prior notice or posting on the website is required before a policy is deemed effective. If there is a discrepancy between the policy effective date and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. All policies are subject to applicable legal and regulatory mandates and requirements for prior notification. The Policy is effective as of the date determined by Health Net. The date of posting is not the effective date of the Policy.
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Medical policy is not intended to override the policy that defines the Member's benefits, nor is it intended to dictate to providers how to practice medicine. To the extent there are any conflicts between medical policy guidelines and applicable contract language, the contract language prevails. In all cases, final benefit determinations are based on the applicable contract language. In order to be eligible, all services must be medically necessary and otherwise defined in the Member's benefits contract as described in this "Important Notice" disclaimer. The clinical criteria and medical policies provide guidelines for determining the medical necessity criteria for specific procedures, equipment and services. The policy provides for clearly written, reasonable and current criteria that have been approved by Health Net's National Medical Advisory Council (MAC). The Member's contract defines which procedure, drug, service, or supply is covered, excluded, limited, or subject to dollar caps. The conclusion that a procedure, drug, service, or supply is medically necessary does not constitute coverage. Health Net may use the Policies to determine whether, under the facts and circumstances of a particular case, the proposed procedure, drug, service, or supply is medically necessary. Coverage determinations are made on a case-by-case basis and are subject to all of the terms, conditions, limitations, and exclusions of the Member's contract, including medical necessity requirements.
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The Policies are based upon a review of the available clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the drug or device, evidence-based guidelines of governmental bodies, and evidence-based guidelines and positions of select national health professional organizations. Health Net's National Medical Policies (the "Policies") are developed to assist Health Net in administering plan benefits and determining whether a particular procedure, drug, service, or supply is medically necessary. Obligations of the Fidelity Entities are neither obligations of, nor guaranteed by, Health Net, Inc. Discounts on vision care services and products made available by EyeMed. Vision plans, other than pediatric vision, are provided by Fidelity Security Life Insurance Company and administered by EyeMed Vision Care, LLC (together, “Fidelity”). Exam copays, lens copays, and material allowances vary by plan.Easy-to-understand benefits and no claim forms for in-network services.Luxottica manufactures some of today's most popular frames, including Vogue, Anne Klein, Giorgio Armani, Persol, and Brooks Brothers.
Your choice of any frames available at provider locations, including current styles from Luxottica.All LensCrafters locations, as well as many independent providers, are open evenings and weekends.Working with trustworthy optometrists is key to maintaining quality eye health and vision over the years.Learn more about which Supplemental Coverage works with your plan. We operate by appointments, but are also available for eye emergencies if you have need. We also offer pre- and post-op care for eye surgeriesīy providing all these eye care services under one roof, we make it easy for you to meet your eye care needs. Detection and management of eye disorders and diseases such as glaucoma, macular degeneration, and cataracts.Contact lens exams and fittings to ensure you get the most accurate prescription for the contacts of your choosing.Inventory of quality prescription eyeglasses, sunglasses and contact lenses to meet your individual need.
If you or your children show signs of refractive errors, we’ll make sure you get an accurate prescription for eyeglasses or contacts to correct shortcomings in your vision.
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As a full service eye care center, we offer an array of eye health and vision services for every stage of your life.
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