59 • Progressive Frames A selection of frames is covered under this Plan. Members must choose a frame from the Anthem formulary. Contact Lenses The Plan offers the following benefits for contact lenses: • Elective Contact Lenses – Contacts chosen for comfort or appearance; • Non-Elective Contact Lenses – Only for the following medical conditions: − Keratoconus when your vision is not correctable to 20/40 in either or both eyes using standard spectacle lenses. − High Ametropia exceeding -12D or +9D in spherical equivalent. − Anisometropia of 3D or more. − When your vision can be corrected three lines of improvement on the visual acuity chart when compared to best corrected standard spectacle lenses. Special Note: Benefits are not available for non-elective contact lenses if the Member has undergone prior elective corneal surgery, such as radial keratotomy (RK), photorefractive keratectomy (PRK), or LASIK. This Plan only covers a choice of contact lenses or eyeglass lenses, but not both. If you choose contact lenses during a Benefit Period, no benefits will be available for eyeglass lenses until the next Benefit Period. If you choose eyeglass lenses during a Benefit Period, no benefits will be available for contact lenses until the next Benefit Period. Vision Services for Members Age 19 and Older The vision benefits described in this section only apply to Members age 19 or older. Routine Eye Exam This Plan covers a complete eye exam with dilation, as needed. The exam is used to check all aspects of your vision. An eye exam does not include a contact lens fitting fee. Vision Services (All Members / All Ages) Benefits include medical and surgical treatment of injuries and illnesses of the eye. Certain vision screenings required by Federal law are covered under the “Preventive Care” benefit. Benefits do not include glasses or contact lenses except as listed in the “Prosthetics” benefit.

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