(a) Each single service HMO evidence of coverage providing vision care services and benefits must provide the following as covered primary and preventive vision services:
  (1) comprehensive eye examination to include medical history;
  (2) visual acuities, with and without correction (distance and near);
  (3) cover test at 20 feet and at 16 inches;
  (4) versions;
  (5) external examination of the eye lids, cornea, conjunctiva, pupillary reaction (neurological integrity), and muscle function;
  (6) binocular measurements for far and near;
  (7) internal eye examination (ophthalmoscopy);
  (8) autorefraction/refraction (far point and near point);
  (9) tonometry (reasonable attempt or equivalent testing if contraindicated);
  (10) retinoscopy;
  (11) biomicroscopy;
  (12) intraocular pressure glaucoma test;
  (13) slit lamp examination; and
  (14) urgent care.
(b) A single service HMO evidence of coverage providing vision care services and benefits may provide coverage for secondary vision care services, which include:
  (1) contact lens examination;
  (2) fitting;
  (3) training;
  (4) follow-up visits; or
  (5) eye glasses.

Source Note: The provisions of this §11.2204 adopted to be effective August 1, 2017, 42 TexReg 2169