OHIO MEDICAID

CARD TYPE	FREQUENCY LIMIT	COVERED SERVICES
OHIO MEDICAID CARD	Age 0-18	Routine Eye Exam, Eyeglass Frame, Spectacle Lenses, once every 365 days.
	Age 19 - 59	Routine Eye Exam, Eyeglass Frame, Spectacle Lenses, once every 2 years.
	Age 60 and over	Routine Eye Exam, Eyeglass Frame, Spectacle Lenses, once every 365 days.
	All Ages	Medical vision care on an as needed basis, with no frequency limit.
	Footnote: We can submit an request for prior authorization of broken or lost eyewear, if you are not due for routine replacement. In addition, if you have a significant prescription change before your allotted replacement, we may also be able to prior authorize a change in eyewear. Replacement subject to approval by Ohio Dept of Jobs & Family Services.
OHIO QMB CARD	Ohio Qualified Medicare Beneficiary (SSI, any age). No frequency limit for covered services.	No eyeglass coverage. No routine vision examination coverage. Covers only MEDICAL eye care for diagnosis and treatment of eye disease. Patient must have presenting symptoms for coverage to apply.
OHIO DISABILITY ASSISTANCE CARD		No coverage of routine eye exams. No coverage for eyeglasses. No coverage at our office for any service. Coverage for medical eye care when seen by an ophthalmologist only.
HEALTH START CARD		Same as Ohio Medicaid Card

DISCLAIMER and STATEMENT OF of FINANCIAL POLICY: Insurance is a contract between the patient and the insurance company. Patient is responsible for any balance not covered by insurance. Determination of benefits is made by your insurer. Any amount not covered by insurance is payable by the patient. Patient is responsible for knowing their insurance coverage, eligibility, covered and non-covered items, PRIOR to delivery of service. We can assist you in determining these. We are happy to submit forms on your behalf.