Policyholder Services



Do I need to complete an exception request if I want to perform a refractive surgery procedure “off-label”?

Not necessarily. Coverage is automatically extended under the Surgery Class 3 rating classification for extraocular refractive surgery procedures (such as PRK and LASIK). When your policy is endorsed for coverage of an intraocular refractive surgery procedure, coverage applies to any such procedure performed within OMIC’s underwriting requirements or any exceptions to the requirements granted in writing by OMIC. An exception is required only if the case falls outside OMIC’s requirements. These requirements often relate to patient selection criteria, informed consent procedures, post-operative care, and other aspects of patient treatment but do not cover all of the many decisions a physician makes when developing a treatment plan. For example, OMIC has not developed requirements regarding the type of lens that may be used during refractive lens exchange. The insertion of multifocal IOLs, which are FDA-approved for use in cataract surgery and are an off-label use in RLE, falls within OMIC’s coverage guidelines; no exception is required. Even where OMIC has developed underwriting requirements, off-label procedures may be permitted. Off-label treatment of patients between the ages of 18 and 21 or over age 45 with phakic implants is permitted subject to special informed consent provisions.

For a complete list of OMIC’s underwriting requirements specific to intraocular refractive surgery, please refer to the applicable refractive surgery questionnaires. OMIC is willing to consider exceptions to its refractive surgery requirements on a patient-by-patient basis due to special situations. However, insureds are encouraged to limit their performance of such procedures to cases that fall within OMIC guidelines. Exceptions may be requested only in extenuating circumstances. If you have a patient who falls outside of OMIC’s requirements but for whom you believe an exception is warranted, please complete an Exception Request Form and return it to OMIC for consideration prior to scheduling surgery.

 

Updated 12/8/2015

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Six reasons OMIC is the best choice for ophthalmologists in America.

#6. Supporting your specialty.

OMIC was founded by members of the American Academy of Ophthalmology nearly a quarter century ago and is the only carrier sponsored and endorsed by AAO. OMIC is also endorsed by 40 other ophthalmic societies. The OMIC partnerships with state and subspecialty societies qualifies their members for an exclusive 8% premium credit. Contact your state society for details.

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