1. (a) A vision benefits plan offered under this program shall exclude:

   1. (1) Any benefits specified as excluded within Section 2699.6721.
   2. (2) Any benefits in excess of limits specified in Section 2699.6721.
   3. (3) Services, supplies, items, procedures or equipment, which are not medically necessary as determined by the plan, unless otherwise specified in Section 2699.6721.
   4. (4) Any benefits that were received prior to the subscriber's effective date of coverage.
   5. (5) Any benefits that were received subsequent to the time the subscriber's coverage ends.
   6. (6) Benefits that are not obtained in compliance with the rules and policies of the subscriber's vision plan.
   7. (7) Orthopics or vision training and any associated supplemental testing.
   8. (8) Aniseikonic lenses.
   9. (9) Plano lenses.
   10. (10) Tinted or photochromic lenses unless otherwise deemed medically necessary.
   11. (11) Two pairs of glasses in lieu of bifocals, unless medically necessary and with the prior authorization of the vision plan.
   12. (12) Replacement or repair of lost or broken lenses or frames.
   13. (13) Medical or surgical treatment of the eyes.
   14. (14) Eye examinations required as a condition of employment.
   15. (15) Any additional costs over and above the plan's frame allowance, as specified in subsections 2699.6725(a)(2) and 2699.6725(b)(2).

Note: Authority cited: Sections 12693.21 and 12693.755, Insurance Code. Reference: Sections 12693.21, 12693.65 and 12693.755, Insurance Code.

History

1. Renumbering of former section 2699.6719 to section 2699.6723, including amendment of section and Note, filed 4-29-2002 as an emergency; operative 4-29-2002 (Register 2002, No. 18). Pursuant to Chapter 946, Statutes of 2000, section 2, a Certificate of Compliance must be transmitted to OAL by 10-28-2002 or emergency language will be repealed by operation of law on the following day.

2. Certificate of Compliance as to 4-29-2002 order transmitted to OAL 10-28-2002 and filed 12-12-2002 (Register 2002, No. 50).

3. Amendment filed 9-15-2008; operative 10-15-2008 (Register 2008, No. 38).

4. New subsection (a)(10) and subsection renumbering filed 1-15-2009, deemed an emergency pursuant to Chapter 758, Statutes of 2008; operative 1-15-2009 (Register 2009, No. 3). A Certificate of Compliance must be transmitted to OAL by 7-14-2009 or emergency language will be repealed by operation of law on the following day.

5. Certificate of Compliance as to 1-15-2009 order transmitted to OAL 7-13-2009 and filed 8-19-2009 (Register 2009, No. 34).