Frames for members age 22 and older
Service Benefit Category Id
11294
Search
Contact lenses for members age 21 and younger
Service Benefit Category Id
11295
Contact lenses for members age 22 and older
Service Benefit Category Id
11296
Prescription lenses (other than contact lenses) for members age 21 and younger
Service Benefit Category Id
11297
Prescription lenses (other than contact lenses) for members age 22 and older
Service Benefit Category Id
11298
Additional orthodontic benefits for eligible members
Service Benefit Category Id
11299
With Choice PCP
Service Benefit Category Id
11300
With Other PCP
Service Benefit Category Id
11301
With Choice PCP - Facility Not Covered by Medicare
Service Benefit Category Id
11303
With Other PCP
Service Benefit Category Id
11304