What services are limited on the HMO plan?
The following information is a listing of general limitations for your health plan and is provided in response to the most frequently asked questions by members. Many covered services are covered according to the Health Advantage Coverage Policy and some services may require prior authorization. Please refer to your Evidence of Coverage and benefit summary for specific information on the terms, conditions, limitations and exclusions for your health plan. Vision Examinations: Routine vision examinations do not require a referral and are limited to one examination per member per contract year. Eyeglasses and contact lenses are not covered except for initial acquisition when purchased within six months following cataract surgery and are subject to a maximum allowable charge of $50 per member per contract year. Mammograms: Breast-cancer screening tests (mammograms) do not require a referral and are limited to one per member per contract year. Annual GYN Visit: Annual GYN visits for cervica
