All commercial health plans offering small group coverage or individual coverage are required to provide eye exams and eyeglasses to children as an essential benefit in 2017

On Monday Aug. 31, the Centers for Medicare & Medicaid Services (CMS) published a list of proposed benchmark health plans for each state for coverage beginning in January, 2017.  The proposed benchmark plans will assure that eye exams and eyeglasses are covered for children in all states.  All health plans offering small group coverage (up to 100 employees) or individual coverage are required to provide these essential benefits, posted here: https://www.cms.gov/CCIIO/Resources/Data-Resources/ehb.html

More specifically, pediatric vision benefits were included in the existing coverage of the proposed benchmark plans in 30 states (including Washington DC).  If the selected benchmark plan did not include coverage for pediatric vision services, then the states were required to supplement their benchmark plan with the benefits covered by Federal Employees Dental and Vision Insurance Program (FEDVIP), which covers annual eye exams and eyeglasses, or the state's Children's Health Insurance Program (CHIP) benefits for pediatric vision.  According to CMS, 18 states will supplement pediatric vision coverage based on FEDVIP, and three states will follow the state CHIP benefits.  A summary is accessible here.

Each state affiliate may want to review the state's proposed benchmark plan for 2017, and consider submitting written comments to HHS in support of the state's selection of a benchmark plan (and any supplementation) that will cover eye exams and glasses.  Public comments will be accepted until 11:59 p.m. EDT on September 30, 2015. Please submit comments electronically to FFEcomments@cms.hhs.gov with the state clearly identified in the subject line (e.g., "Maryland 2017 Benchmark Plan Comments"). The CMS Center for Consumer Information and Insurance Oversight (CCIIO) will review all comments and then post the list of final 2017 EHB benchmark plans.

For the essential benefits for 2014-2016, 38 states and DC supplemented their benchmark plans with FEDVIP, 7 states opted for their CHIP plan benefits, and 5 states selected a benchmark plan that included pediatric vision benefits. 

For any questions, please contact the AOA Third Party Center at tpc@aoa.org.