1. (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. (1) comprehensive eye examination to include medical history;
   2. (2) visual acuities, with and without correction (distance and near);
   3. (3) cover test at 20 feet and at 16 inches;
   4. (4) versions;
   5. (5) external examination of the eye lids, cornea, conjunctiva, pupillary reaction (neurological integrity), and muscle function;
   6. (6) binocular measurements for far and near;
   7. (7) internal eye examination (ophthalmoscopy);
   8. (8) autorefraction/refraction (far point and near point);
   9. (9) tonometry (reasonable attempt or equivalent testing if contraindicated);
   10. (10) retinoscopy;
   11. (11) biomicroscopy;
   12. (12) intraocular pressure glaucoma test;
   13. (13) slit lamp examination; and
   14. (14) urgent care.

2. (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. (1) contact lens examination;
   2. (2) fitting;
   3. (3) training;
   4. (4) follow-up visits; or
   5. (5) eye glasses.

Source Note:The provisions of this §11.2204 adopted to be effective August 1, 2017, 42 TexReg 2169.