Overview
Provider Type
- Participating Physician Groups (PPG)
Wellcare by Health Net's vision plan is an option available to some Health Net employer groups and individual plan members. Wellcare by Health Net contracts with Envolve Vision or with participating physician groups (PPGs) in certain geographic areas, to provide vision benefits to some Health Net Medicare Advantage (MA) plan members. Refer to the member's Evidence of Coverage (EOC) or Schedule of Benefits for covered services.
For members assigned to a capitated PPG, vision examinations are covered through the member's PPG. Members may request an appointment for a vision examination with the PPG.
A member with a Wellcare By Health Net vision plan can request an appointment for a vision examination through the PPG.
Under the vision plan, if the member requires eyeglasses, a prescription is written, and the member may purchase eyewear from a participating eyewear dispenser in California or through Envolve Vision.
Lenses following cataract surgery are covered by the medical plan. Refractive lenses are covered when they are medically necessary to restore the vision normally provided by the natural lens of the eye of an individual lacking the organic lens due to surgical removal or congenital absence. Covered diagnoses are limited to pseudophakia (ICD-10 Z96.1), aphakia (ICD-10 H27.00-H27.03) and congenital aphakia (ICD-10 Q12.3). Under Medicare guidelines, one pair of contact lenses or eyeglasses is covered following each cataract surgery in addition to the surgically implanted intraocular lens (IOC).
Overview (Physicians only)
Wellcare By Health Net's vision plan is an option available to some Health Net employer groups and individual plan members. Health Net contracts with Envolve Vision to provide vision benefits to some Health Net Medicare Advantage (MA) plan members.
If the member is assigned a fee-for-service (FFS) primary care physician (PCP), the PCP refers the member for a vision examination.
Under the vision plan, if the member requires eyeglasses, a prescription is written, and the member may purchase eyewear from a participating eyewear dispenser in California or through Envolve Vision.
Lenses following cataract surgery are covered by the medical plan. Refractive lenses are covered when they are medically necessary to restore the vision normally provided by the natural lens of the eye of an individual lacking the organic lens due to surgical removal or congenital absence. Covered diagnoses are limited to pseudophakia (ICD-10 Z96.1), aphakia (ICD-10 H27.00-H27.03) and congenital aphakia (ICD-10 Q12.3). Under Medicare guidelines, one pair of contact lenses or eyeglasses is covered following each cataract surgery in addition to the surgically implanted intraocular lens (IOC).
Wellcare By Health Net covers the surgically implanted conventional IOL and a pair of glasses to replace the organic eye lens following the surgical extraction of a cataract.
Post-cataract surgery eyeglasses or post-cataract surgery contact lenses are covered under the prosthetic benefit for members who did not receive an implanted lens after lens extraction.