Chapter 7. Vision Benefits And Copayments of California Insurance Code >> Division 2. >> Part 6.2. >> Chapter 7.
(a) Vision benefits shall be provided to subscribers and
shall meet the federal coverage requirements in Section 2103 of Title
XXI of the Social Security Act.
(b) The covered benefits shall be equivalent to those provided to
state employees through the Department of Human Resources, except for
tinted lenses and also photochromatic lenses, unless otherwise
deemed medically necessary.
(c) The board shall establish the required subscriber copayment
levels for vision benefits consistent with the limitations of Section
2103 of Title XXI of the Social Security Act. The copayment levels
established by the board shall, to the extent possible, reflect the
copayment levels provided to state employees through the Department
of Human Resources.
(d) From March 1, 2011, to June 30, 2012, inclusive, the adoption
and readoption, by the board, of regulations to modify vision
benefits pursuant to this section, including, but not limited to,
restriction of providers through which covered vision benefits may be
obtained, restriction of benefits for services from nonparticipating
providers, or restriction of products and materials provided as
benefits pursuant to this section, shall be deemed to be an emergency
and necessary to avoid serious harm to the public peace, health,
safety, or general welfare for purposes of Sections 11346.1 and
11349.6 of the Government Code, and the board is hereby exempted from
the requirement that it describe facts showing the need for
immediate action and from review by the Office of Administrative Law.
Notwithstanding any other provision of law, for a
subscriber who is determined by the California Children's Services
Program to be eligible for benefits under the program pursuant to
Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of
Division 106 of the Health and Safety Code, a participating plan
shall not be responsible for the provision of, or payment for, the
particular services authorized by the California Children's Services
Program for the particular subscriber for the treatment of a
California Children's Services Program eligible medical condition.
All other services provided under the participating plan shall be
available to the subscriber.