Policyholder Services

Retinopathy of Prematurity (ROP) Application

Physicians who render ROP services to infants when they are less than 55 weeks post-menstrual age (gestational age plus post-natal age) must complete a supplemental questionnaire and abide by OMIC’s underwriting requirements for the screening for and treatment of retinopathy of prematurity. Completion of this form is not required if you provide care only to infants with a history of ROP for other conditions such as amblyopia or myopia.

Download OMIC’s application for Retinopathy of Prematurity using the toolbar above.

If you will be performing remote screening for ROP, you must also complete a separate Remote Screening Application.

If you have any questions about OMIC’s coverage visit the Coverage Q&A section or Contact Your Rep.

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