Kaiser Vision Benefits

State of Maryland

Employee Vision Benets

Kaiser Permanente Optical Shops deliver

convenience, quality, and peace of mind.

kp2020.org

Convenience. You can nd our eye care services in many of our medical centers, plus other services like primary

care, pharmacy, and more. It’s easy to take care of your health needs—including vision—in one trip. You don’t

even need a referral for a basic eye exam. To schedule an appointment, just call 855-839-5763 (TTY 711), 7 days

a week, 7 a.m. to 11 p.m.

Quality. Choose from a wide selection of frames, lenses, and contact lenses to nd the right t for your lifestyle

and budget. We carry brands like Calvin Klein, Nike, and Ray-Ban, plus a full line of sunglasses for both children

and adults.

Peace of mind. Any glasses from Vision Essentials come with a 30-day total satisfaction guarantee.

Speak with your local Vision Essentials provider for more information.

Pediatric eye exams

Get one routine eye exam per plan year without a referral, at no charge. A routine eye exam includes

a vision check and various eye health tests for glaucoma, etc. This benet is available to members 19 and

under, lasting through the end of the month that they turn 19.

VISION HARDWARE ALLOWED BENEFIT

Frames $70

Single vision lenses $40

Bifocal lenses $60

Trifocal lenses $80

Lenticular lenses $100

Contact lenses (instead of frames and lenses) $105

Medically necessary contact lenses $225

Child vision

(Age 18 and under, plus the full month of the member’s 19

birthday)

For children, the State of Maryland offers compensation for various vision hardware listed below. The State

of Maryland will pay the specic dollar amount, and the member pays any remaining cost.

This does not include spectacle lenses with add-ons, such as glare-resistant treatment, ultraviolet coating,

progressive lenses, or transitional lenses.

Pediatric lenses and frames

Get eyeglass frames and lenses at no charge from a Kaiser Permanente Optical Shop. Contact lenses,

including medically necessary contact lenses, may be covered instead of eyeglasses. This benet is

available to members 19 and under, lasting through the end of the month that they turn 19.

The value of the free pair of glasses may not be applied toward the cost of other glasses or contact lenses.

However, there is an allowance for additional glasses or contact lenses.

Members may also be covered for glasses and contact lenses outside of the select group. See the sections

below for details: Eyeglass lenses, Eyeglass frames, and Contact lenses.

Eyeglass lenses

Includes any regular eyeglass lenses with a refractive value. If only one eye needs correction, we also

provide a balance lens for the other eye.

Eyeglass frames

Includes original tting of the frames, adjustment of frames, and mounting eyeglass lenses in the frame.

Contact lenses

Includes a rst-time tting for contact lenses at a Kaiser Permanente Optical Shop. A rst-time tting

includes the use of diagnostic lenses to check the t, training to insert and remove contact lenses, and

three months of follow-up visits.

VISION HARDWARE ALLOWED BENEFIT

Frames $45

Single vision lenses $52

Bifocal lenses $82

Trifocal lenses $101

Lenticular lenses $181

Contact lenses (instead of frames and lenses) $97

Medically necessary contact lenses $285

EYE EXAMS ALLOWED BENEFIT

Routine (once per plan year—no referrals) No charge

Non-routine $15 per visit

Adult vision

(Age 19 and older)

For additional information regarding your vision benets, including a complete list of

exclusions and limitations, please see your Evidence of Coverage.

Visit kp2020.org for more information and locations.

Questions? Contact Kaiser Permanente Member Services at 855-839-5763 (TTY 711), 7 days

a week, 7 a.m. to 11 p.m.

Vision services coverage and exceptions (for adults)

We cover medically necessary treatment for eye injuries and diseases. Such treatment shall be

covered to the same extent as for other medically necessary treatments for illness or injury.

This does not include:

• Vision correction, including vision checks and prescriptions for corrective lenses

• Contact lenses services, including vision checks, ttings, and follow-up visits

• Eyeglass lenses and frames

• Sunglasses without corrective lenses (unless medically necessary)

• Orthoptic therapy, including eye training and exercises

• Any eye surgery intended to correct vision rather than an injury or disease

Eye exams coverage and exceptions (for adults)

We cover routine and medically necessary eye exams. This includes vision checks and various eye

health tests for glaucoma, etc.

This does not include:

• Contact lenses services, including vision checks, ttings, and follow-up visits

• Orthoptic therapy, including eye training and exercises

• Any eye surgery intended to correct vision rather than an injury or disease

• Replacement of lost or broken lenses or frames

Prescriptions

Members can ll their prescriptions at a Kaiser Permanente facility or any location of their choice.

For additional information regarding your vision benets, including a complete list of

exclusions and limitations, please see your Evidence of Coverage.

Vision Essentials locations

For more information about Vision Essentials locations near you, visit kp2020.org.

DISTRICT OF COLUMBIA

Kaiser Permanente Capitol Hill Medical Center

700 2nd St. NE, Washington, DC 20002

202-346-3000 (TTY 711)

MARYLAND

Camp Springs Medical Center

6104 Old Branch Ave., Temple Hills, MD 20748

301-702-6100 (TTY 711)

Gaithersburg Medical Center

655 Watkins Mill Road, Gaithersburg, MD 20879

240-632-4000 (TTY 711)

Kensington Medical Center

10810 Connecticut Ave., Kensington, MD 20895

301-929-7100 (TTY 711)

Largo Medical Center

1221 Mercantile Lane, Largo, MD 20774

301-618-5500 (TTY 711)

Lutherville-Timonium Medical Center

2391 Greenspring Drive, Lutherville-Timonium,

MD 21093

410-847-3000 (TTY 711)

Marlow Heights Medical Center

5100 Auth Way, Suitland, MD 20746

301-702-5000 (TTY 711)

North Arundel Medical Center

7670 Quartereld Road, Glen Burnie, MD 21061

800-777-7904 (TTY 711)

Silver Spring Medical Center

12201 Plum Orchard Drive, Silver Spring, MD 20904

301-572-1000 (TTY 711)

Woodlawn Medical Center

7141 Security Blvd., Baltimore, MD 21244

443-663-6000 (TTY 711)

VIRGINIA

Alexandria Medical Center

3000 Potomac Ave., Alexandria, VA 22301

703-721-6300 (TTY 711)

Ashburn Medical Center

43480 Yukon Drive, Ashburn, VA 20147

571-252-6000 (TTY 711)

Burke Medical Center

5999 Burke Commons Road, Burke, VA 22015

703-249-7700 (TTY 711)

Caton Hill Medical Center

(opening fall 2022)

13285 Minnieville Road, Woodbridge, VA 22192

1-800-777-7904 (TTY 711)

Colonial Forge Medical Center

(building located on the grounds of Stafford Hospital)

125 Hospital Center Blvd., Stafford, VA 22554

540-602-6500 (TTY 711)

Fair Oaks Medical Center

12255 Fair Lakes Parkway, Fairfax, VA 22033

703-934-5700 (TTY 711)

Falls Church Medical Center

201 N Washington St., Falls Church, VA 22046

703-237-4000 (TTY 711)

Haymarket Crossroads Medical Center

15050 Heathcote Blvd., Haymarket, VA 20169

571-445-7200 (TTY 711)

Reston Medical Center

1890 Metro Center Drive, Reston, VA 20190

703-709-1500 (TTY 711)

Springeld Medical Center

6501 Loisdale Court, Springeld, VA 22150

703-922-1000 (TTY 711)

Tysons Corner Medical Center

8008 Westpark Drive, McLean, VA 22102

703-287-6400 (TTY 711)

Woodbridge Medical Center

(will close when Caton Hill Medical Center opens)

14139 Potomac Mills Road, Woodbridge, VA 22192

703-490-8400 (TTY 711)

Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.

2101 E. Jefferson St., Rockville, MD 20852 2022ML0347 MAS 4/15/22-12/31/23