* Medically necessary (prior authorization required) is the following situations:
1. Following cataract surgery;
2. When visual acuity cannot be corrected to 20/70 in the better eye except by their use;
3. Anisometropia of greater than 3.50 diopters and aesthenopia or diplopia, with spectacles;
4. Keratoconus diagnosis where contact lenses are treatment of choice;
5. Monocular aphakia and/or binocular aphakia where the doctor certifies contact lenses are medically necessary for safety and rehabilitation to a productive life.**Benefits include (1) The cost of an annual vision exam, subject to the copayment; and (2) the cost of contact lenses, any fitting costs and follow-up visit up to the maximum of $120, not subject to the copayment. This is in lieu of all other benefits and not available when benefits for eyeglasses are received. ***The frame allowance is based on a wholesale amount. If the actual wholesale cost exceeds the wholesale frame allowance, you will be required to pay twice the wholesale difference. This schedule shows only a few of the covered procedures. This schedule is intended for comparison purposes only. The benefits of each plan will be determined by the contract. For a complete listing of benefits and exclusions and limitations, please reference your certificate of coverage. | 
