HI 00620.110 Routine Services and Appliances
Routine physical checkups; eyeglasses, and eye examinations for the purpose of prescribing,
fitting, or changing eyeglasses (see HI 00620.200) hearing aids and examinations for hearing aids; and immunizations are not covered.
Routine physical checkups include examinations performed without relationship to treatment
or diagnosis for a specific illness, symptom, complaint, or injury, and examinations
required by third parties such as insurance companies, business establishments or
The exclusions apply to eyeglasses or contact lenses, and eye examinations for the
purpose of prescribing, fitting, or changing eyeglasses or contact lenses for refractive
errors. The exclusions do not apply to services performed in conjunction with an eye
disease, as glaucoma or cataracts, or to postsurgical prosthetic lenses which are
customarily used during convalescence from eye surgery in which the lens of the eye
was removed, or to permanent prothetic lenses required by an individual lacking the
organic lens of the eye, whether by surgical removal or congenital absence.
Vaccinations and inoculations are excluded as “immunizations” unless they are directly related to the treatment of an injury or direct exposure
such as antirabies treatment, tetanus antitoxin or booster vaccine botulin antitoxin,
antivenin, or immune globulin. See HI 00610.306 regarding the coverage of pneumococcal vaccine and its administration.