Blue Cross Blue Shield FEP Vision Brochure - 2024

Blue Cross Blue Shield FEP Vision
Section 7 General Exclusions – Things We Do Not Cover
Section 7 General Exclusions – Things We Do Not Cover
The exclusions in this section apply to all benefits.

We do not cover the following:
  • Services provided by non-participating providers for Standard Option members;
  • Any charges in excess of the benefit, dollar, or supply limits stated in this brochure;
  • Any vision service, treatment or materials not specifically listed as a covered service;
  • Any exams given during your stay in a hospital or other facility for medical care;
  • Drugs or medicines;
  • Services and materials that are experimental or investigational;
  • Services or materials which are rendered prior to your effective date;
  • Services and materials incurred after the termination date of your coverage unless otherwise indicated;
  • Services and materials not meeting accepted standards of optometric practice;
  • Services and materials resulting from your failure to comply with professionally prescribed treatment;
  • Benefits may not be combined with any discount or promotional offering unless otherwise noted in an offer.
  • Telephone consultations;
  • Any charges for failure to keep a scheduled appointment;
  • Any services that are strictly cosmetic in nature including, but not limited to, charges for personalization or characterization of prosthetic appliances;
  • Services or materials provided as a result of intentionally self-inflicted injury or illness;
  • Services or materials provided as a result of injuries suffered while committing or attempting to commit a felony, engaging in an illegal occupation, or participating in a riot, rebellion or insurrection;
  • Office infection control charges;
  • Charges for copies of your records, charts, or any costs associated with forwarding/mailing copies of your records or charts;
  • State or territorial taxes on vision services and materials;
  • Medical treatment of eye disease or injury;
  • Special vision procedures, such as orthoptics, vision therapy or vision training;
  • Special lens designs or coatings other than those described in this brochure;
  • Special supplies such as nonprescription sunglasses and subnormal vision aids;
  • Replacement of lost/stolen eyewear;
  • Non-prescription (Plano) lenses;
  • Two pairs of eyeglasses in lieu of bifocals;
  • Services not performed by licensed personnel;
  • Prosthetic devices and services or digital devices such as iPads, cell phones, etc.;
  • Insurance of contact lenses;
  • Professional services you receive from immediate relatives or household members, such as a spouse, parent, child, sibling, by blood, marriage or adoption.
  • Deductibles, copayments and coinsurance for medical services or other insurance are not reimbursable.