Eligible members can use the LightCare enhancement for plano (non-prescription), ready-made sunglasses or blue light filtering glasses instead of contact lenses or prescription glasses, exhausting both their lens and frame eligibility.

Eligible members will be indicated with the following comment on the Patient Record Report:

Frames

Coverage includes any ready-made, doctor-supplied plano sunglasses or plano blue light filtering glasses. Apply the patient's retail frame allowance to the cost of the complete pair (lens and frame). Deduct 20% from any amount over their retail allowance. Sunglasses can be ordered if not available at the time of the member’s visit. If you do not supply an inventory of ready-made blue light glasses, you can refer patient to Eyeconic. The $20 and $40 Marchon/Altair frame promotions apply to LightCare.

Lenses

To cover the lenses, the patient must select the lenses included in the frame with no additional enhancements or coatings.

When submitting claims for non-prescription sunglasses or blue light filtering glasses on eClaim, indicate the order as a “frame only” order.

A diagnosis code is required for claim submission. For frame-only claim submission, use Z46.0 (Encounter for fitting and adjustment of spectacles and contact lenses) or other relevant diagnosis code(s), as appropriate. Including a diagnosis code will ensure correct claims processing.

For all eligible LightCare Plan Enhancement claims, you’ll be reimbursed both your frame dispensing fee and a frame material fee (up to the patient’s wholesale/retail frame allowance).

See Services Subject to Review/Audit for information regarding material record keeping requirements.