Here are some important things to know before you seek eye-care services.
US Family Health Plan covers one eye examination per Plan Year (January 1 through December 31) by a participating provider.
The difference between an optometrist and an ophthalmologist
An optometrist is a medical professional who is trained and licensed to examine eyes for visual defects, diagnose problems or impairments, and prescribe corrective lenses or provide other types of treatment. Ordinarily, members see an optometrist for routine eye care.
An ophthalmologist is a medical doctor who specializes in diseases of the eye and provides treatment of non-routine medical conditions. As is the case with all specialists, you need a referral from your PCP for any and all ophthalmology services.
Routine eye exams (vision check for corrective lenses)
Covered routine eye care with an optometrist must be provided by an EyeMed network provider.
Medical/non-routine eye care with an optometrist
Covered services by an optometrist must occur within the EyeMed network. No referral is required.
Medical/non-routine eye care with an ophthalmologist
Covered services (for example, an eye exam if you have glaucoma or diabetes) by an ophthalmologist must occur within the Tufts Health Plan network and require a referral from your PCP.
To find network providers
US Family Health Plan: