Anthem

 

Value-added benefits (VAB)

Anthem offers a value-added benefit for Medicaid members based on their age. There are no copays for VAB.

Benefits may vary. Always pay close attention to the benefits to make sure you’re providing the appropriate covered services and materials.

Refer to the EyeMed Ohio Medicaid Provider Manual (requires inFocus login to access) for full details.

• Members aged 20 and younger receive a $100 allowance towards the purchase and fitting of contact lenses or an additional pair of eyeglasses per calendar year.
• Members aged 21 to 59 receive 1 comprehensive eye exam and a $100 allowance towards the purchase and fitting of contact lenses or an additional pair of eyeglasses per calendar year.
• NOTE: These allowances can’t be applied to any base benefit to which a Medicaid member is entitled, nor can the allowance be used to upgrade a base benefit. Allowances can only be used toward the purchase of additional contacts and corresponding fitting, or an additional complete pair of glasses after the base vision benefit(s) are exhausted.

 

Materials

Lenses

Medicaid considers standard lenses to be CR-39 plastic single vision with scratch-resistant coating or glass.

• Polycarbonate lenses are covered for all beneficiaries.
• Tints are covered only when medically necessary for conditions such as photophobia or albinism.
• Any other lens types and options are covered only when medically necessary.

Refer to the EyeMed Ohio Medicaid Provider Manual for full details. You must be logged into your account on inFocus to access the manual.

Contact lenses

You’ll file medically necessary contact lens claims on paper using the EyeMed Ohio Medicaid claim form.

Members qualify for medically necessary contact lens benefits for any of the below conditions:

• Aphakia
• Anisometropia
• Hyperopia
• Myopia
• Keratoconus
• Corneal Ectasia
• Other Corneal Deformities

 

Eyewear buy-ups

There are no buy-up options in the state of Ohio. If the Medicaid member wishes to purchase eyewear that exceeds their covered benefits, the member is responsible for paying out-of-pocket to cover the remaining costs.

 

Member ID cards 

Medicaid members will present Anthem ID cards like the ones below.

Anthem — Ohio Member ID card:

Anthem — Ohio Member ID card with OhioRISE and CSP enrollment:

Anthem — Ohio Member ID card with OhioRISE without CSP enrollment:

Anthem — Ohio Member ID card with CSP enrollment:

 

Related provider resources Provider Manual – Ohio Medicaid Registering for Medicaid network labs Filing claims for Medicaid Medically Necessary Contact Lens Form – Ohio Medicaid