HIP Plus Gets You More

Covered Routine Care

• Evaluations and cleanings (2 per person per benefit year)
• Bitewing x-rays (4 x-rays per person per benefit year)
• Comprehensive x-rays (1 complete set every 5 years)
• Minor restorative services, such as fillings (4 per person per benefit year)
• Major restorative services, such as crowns (1 per person per benefit year)

• Members ages 19 and 20:

1. One routine vision exam every year
2. New eyeglasses after your exam if your vision has changed significantly since your last pair, or as determined by your doctor.

• Members ages 21 and older:

1. One routine vision exam every two years.
2. New eyeglasses after your exam if your vision has changed significantly since your last pair, or as determined by your doctor. If your vision has not changed, then you are covered for new eyeglasses once every five years.

Additional Coverage

• Replacement eyeglasses and/or frames for lost, damaged, or stolen frames, as determined by your doctor.
• Contact lenses are covered if you have a medical reason you cannot wear glasses, as determined by your doctor.
• Medically necessary eye tests and treatment for members with eye disease or other diseases that affect the eyes.
• Vision surgery and training therapies are covered if medically necessary, as determined by your doctor.

• Annual limit of 6 spinal manipulation visits per covered person per benefit year.
• Self-referral – provider referral is not required
• No prior authorization is needed
• Coverage available for covered services provided by a licensed chiropractor when rendered within the scope of the practice of chiropractic.