PPG Responsibility

The participating physician group (PPG) must develop a simple office-screening procedure to provide routine vision screening. The screening should include testing for a deviation of the eyes from normal. If the vision exam indicates a potential refractive problem, a referral must be made for a refraction exam only. Health Net suggests that the PPG use the Snellen and Jaeger tests and include the use of the Titmus Machine Vision Tester. This enables the PPG to screen out many potential referrals.

PPGs must provide members who want or need contact lenses a prescription for corrective lenses, including eye curvature measurements and fitting of contact lenses (a fitting could involve multiple visits).

After an optometrist or ophthalmologist performs a refractive vision exam and determines that a member's vision can be improved by eyeglasses, the member may obtain the eyeglasses either from the optometrist or ophthalmologist who performed the vision exam or elsewhere. If the optometrist or ophthalmologist determines that the member's vision can be improved only by contact lenses or the member prefers contact lenses and the optometrist or ophthalmologist determines that contact lenses are a medically viable way to correct the member's vision, the member may obtain the contact lenses either from the optometrist or ophthalmologist who performed the vision exam or elsewhere. If the member decides to obtain the eyeglasses or contact lenses elsewhere, the optometrist or ophthalmologist must give the member a prescription for the glasses or a prescription that includes the necessary measurements to enable purchase of the contact lenses.

Members enrolled in the EyeMed Vision Care vision plan must utilize EyeMed Vision Care participating providers.