Member Information

Vision Services

Vision Services are provided by EyeMed Vision Care.

To find a participating provider, call EyeMed Vision Care at 1-888-610-2268 or visit EyeMed.com. EyeMed’s hours are 9 a.m. to 8:30 p.m. Monday through Friday, and Saturdays from 9 a.m. to 5 p.m.

Benefits:

Routine eye examinations for all enrollees shall be allowed at least once every 2 years.

Each Optima Family Care/FAMIS* member under age 21 is eligible to receive the following services:

  • Writing of lens formulas and prescriptions
  • Dispensing/fitting procedure
  • Subsequent glasses adjustments as necessary
  • If prescribed, each member is entitled to one of the following:*
    • One pair of glasses with clear plastic single vision lenses, or
    • One pair of glasses with multifocal plastic lenses, or
    • One pair of glasses frames chosen from a selection on display in the provider’s office, or
    • One pair of contact lenses, only if medically necessary

*Note: No more than one pair of glasses will be allowed within a 24 month period without a statement of medical need.

You are fully covered for these services and materials, as long as they are provided by an EyeMed provider. If you select frames or lenses costing more than the amount covered by an Optima Health insurance plan, you are responsible for the additional charge.

Prior authorization is needed for contact lenses and only as a result of any of the following conditions:

  • To correct extreme visual acuity problems that cannot be corrected with lenses,
  • Certain conditions of anisometropia, or
  • Keratoconus

Members at or over the age of 21 will receive the following discounts:

  • Standard Plastic Lenses priced at:
    • $50 for Single Vision
    • $70 for Bifocal
    • $105 for Trifocal
  • 40% off frames
  • Contact lenses, 15% off conventional, no discount for disposal contact lenses (discounts and fees apply only if a complete pair is purchased in the same transaction.)
  • Laser vision correction surgery (e.g. LASIK) 15% off retail price or 5% off discount on promotional price discount.

NOTE: FAMIS members please see Summary of Benefits in your member guide for Copayment information.

Dental Services

Dental Services are covered for members under age 21 through Smiles for Children.

Effective March 1, 2015, pregnant women enrolled in Medicaid and FAMIS MOMS who are 21 years of age and older are eligible to receive comprehensive benefits, excluding Orthodontics, covered by the Smiles For Children program. Dental benefits for pregnant women who are 21 years of age and older will be discontinued at the end of the month following their 60th day postpartum.

All Optima Family Care/FAMIS members are covered for medically necessary services resulting from a dental accident or for medically necessary procedures to the mouth where the main purpose is not to treat the teeth.

Medically necessary services include:

  • Dental services performed by a medical provider as the result of a dental accident
  • Hospitalization and Anesthesia Related Services for medically necessary dental services including extractions
  • Transportation and medical care related to dental services (Does not apply to FAMIS)
  • Medically necessary dental services performed during an emergency room visit immediately after the traumatic injury and in conjunction with the initial stabilization of the traumatic injury are covered subject to utilization review for medical necessity

Contact Smiles for Children at 1-888-912-3456 or visit Smiles for Children.

Partners in Pregnancy

Optima Family Care recognizes that pregnancy in itself can be a life-altering journey and even the most experienced mom may feel in need of extra support. That’s why we developed Optima’s Partners in Pregnancy Program -- a program dedicated to providing guidance, support, and education to all expectant moms with Optima Health insurance.

Learn more about Partners in Pregnancy

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