Section 11.2204 - Minimum Standards - Vision Care Services and Benefits(a) Each single service HMO evidence of coverage providing vision care services and benefits must provide the following as covered primary and preventive vision services: (1) comprehensive eye examination to include medical history;(2) visual acuities, with and without correction (distance and near);(3) cover test at 20 feet and at 16 inches;(5) external examination of the eye lids, cornea, conjunctiva, pupillary reaction (neurological integrity), and muscle function;(6) binocular measurements for far and near;(7) internal eye examination (ophthalmoscopy);(8) autorefraction/refraction (far point and near point);(9) tonometry (reasonable attempt or equivalent testing if contraindicated);(12) intraocular pressure glaucoma test;(13) slit lamp examination; and(b) A single service HMO evidence of coverage providing vision care services and benefits may provide coverage for secondary vision care services, which include: (1) contact lens examination;28 Tex. Admin. Code § 11.2204
The provisions of this §11.2204 adopted to be effective November 2, 1998, 23 TexReg 11347; amended to be effective February 24, 2005, 30 TexReg 854; Adopted by Texas Register, Volume 42, Number 16, April 21, 2017, TexReg 2263, eff. 8/1/2017