Compare vision plans

Find out about PEBB vision plans available to you and your dependents. You and any enrolled dependents must be enrolled in the same PEBB vision plan.

Before you select a vision plan, call the plan to see if your vision provider is in the plan's network.

Full benefits

The following documents—called a Certificate of Coverage (COC)—provide in-depth descriptions of the benefits for the plan.

How do the vision plans compare?

Before you enroll in a vision plan, use the Vision Benefits Comparison to get the details you need to help you decide. 

For information on specific benefits and exclusions, review the plan's certificate of coverage (COC) or call the plan.

What does a vision plan cover?

Vision plans cover:

  • An eye exam (once every year)
  • A set of lenses (Benefit resets every January 1 of odd years)

Vision plans give an allowance toward new frames or contacts (in lieu of glasses) every January 1 of odd years (2025, 2027, etc.)

Some plans may also include discounts on laser vision correction, or LASIK.

Does my medical plan cover vision?

Your medical plan covers general eye health.

If you have an eye problem that’s related to a medical condition, such as cataracts, diabetes, or an injury, then your medical plan will more than likely cover you. These types of claims would fall under medical insurance; whereas a vision exam and glasses would fall under vision insurance.

For example: If your eye doctor was fitting you for contact lenses and discovered a torn retina, your medical plan would cover further exams and visits until it was resolved. A torn retina is a medical problem, not a vision correction issue.

What providers can I see?

Before you select a vision plan, call the plan to see if your vision provider is in the plan's network.

Davis Vision by MetLife

Visit Davis Vision by MetLife's provider search.

EyeMed

Visit EyeMed's provider search.

MetLife Vision

Visit MetLife Vision's provider search.

Preauthorization criteria

Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. Preauthorization is not a guarantee, however, that your plan will pay for those services, supplies, or drugs.

These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

Frenotomy and frenectomy with breastfeeding support

Frenectomy, frenotomy (also called frenulotomy), and frenoloplasty are sometimes used interchangeably but refer to different procedures to release the frenum to treat tongue-tie (ankyloglossia) in infants. Ankyloglossia is a condition that limits how well an infant can move their tongue and may sometimes cause breastfeeding difficulties.

Status: Decision complete

Why is frenotomy and frenectomy being reviewed?

Frenectomy and frenotomy for breastfeeding support were selected for a health technology assessment (HTA) because of high concerns for efficacy, and medium concerns for safety and cost.

Primary criteria ranking

  • Safety = Medium
  • Efficacy = High
  • Cost = Medium

Documentation

Assessment timeline

  • Draft key questions published: September 26, 2024
    • Public comment period: September 26 to October 10, 2024
  • Final key questions October 24, 2024
  • Draft report published: March 4, 2025
    • Public comment period: March 4 to April 4, 2025
  • Final report published: May 14, 2025
  • HTCC public meeting: June 13, 2025
  • Draft findings and decision published: June 24, 2025 
    • Public comment period: June 24 to July 8, 2025
  • Final findings and decision published: July 22, 2025

Certified Community Behavioral Health Clinics

Certified Community Behavioral Health Clinics (CCBHC) are specially-designated clinics that provide a comprehensive range of mental health and substance use services.

What is a CCBHC?

A CCBHC is a provider who has met the SAMHSA requirements for eligible providers and the criteria to provide all required services. They must provide service to any individual who presents in their clinic, regardless of ability to pay or insurance.

Read the scope of services and activities.

Read the most recent CCBHC cost reporting FAQ.

Areas of service

Clinics must provide nine total areas of service:

  • Screening, assessment, diagnosis
  • Patient-centered treatment planning
  • Outpatient mental health/substance use disorder treatment
  • Crisis services (24-hour mobile crisis, crisis stabilization)*
  • Peer support
  • Psychiatric rehab
  • Targeted case management
  • Primary health screening and monitoring
  • Armed forces and veteran’s services

A minimum of 51 percent of the services must be provided by the CCBHC, with the remainder provided by either the CCBHC or a Designated Collaborating Organization (DCO).

Our state has the goal to increase the number of CCBHCs so that every Washingtonian can easily access the services. Visit the CCBHC locator to find a clinic near you.

*After-hours crisis services may be provided by a state-sanctioned system.

SAMHSA planning grants

The CCBHC planning grant is a SAMSHA grant that will provide additional funding to develop the CCBHC certification and payment structure models.

The purpose of this grant is to:

  • Support states in developing and implementing certification systems for CCBHCs.
  • Establish prospective payment systems for Medicaid reimbursable behavioral health services.
  • Prepare an application to participate in a four-year CCBHC Demonstration program.

CCBHC is a clinical model that requires certification by the state government. SAMHSA has grants that support both clinics and state governments. The Health Care Authority has applied for a planning grant to assist with the development of the Prospective Payment System (PPS). We are planning on launching this certification process and the payment mechanism for CCBHCs by 2027.

Key dates

Dates are subject to change at the convenience of Tribal Nations or HCA.

  • Monday, January 12, 2026 to Monday, February 2
    • Provide draft cost report to HCA
  • Monday, March 23, 2026
    • Provide final cost report to HCA
  • Friday, January 1, 2027
    • Certification effective start (go-live)

Why is there a change to the draft cost report?

To give provisionally certified CCBHCs additional time to complete their cost report materials. HCA has offered a 3-week extension, with an updated due date of Monday, February 2, 2026. 

The final submission date of Monday, March 23 is fixed due to HCA’s anticipated SAMHSA CCBHC Demonstration Application due date of April 1, 2026.

Please submit your cost reports as soon as possible so that HCA can begin our review. HCA is available for one-on-one cost report TA either through email or by scheduling a meeting. TA requests can be submitted to: HCA CCBHC.

Meetings and materials

Past meetings

Tribal engagement timeline started in August of 2025 to September 11, 2025

Date Type Materials
January 13, 2026 Technical assistance call Cost reporting FAQ (1/16/2026)
December 17, 2025 Technical assistance call: cost reporting Cost reporting presentation (12/17/2025)
December 13, 2025 Technical provider work group meeting  
November 17, 2025 Technical assistance call: cost reporting Cost reporting presentation (11/17/2025)
November 13, 2025 Technical assistance call FAQ (11/13/2025)
November 6, 2025 Technical assistance call: cost reporting Cost reporting presentation (11/6/2025)
October 4, 2025 Technical assistance call: financial information request Financial information request FAQ (10/4/2025)
August 28, 2025 CCBHC technical assistance call Watch the recording (08/28/2025)
August 13, 2025 Monthly Tribal meeting Tribal meeting presentation (08/13/2025)
August 11, 2025 Provider technical assistance Meeting notes (08/11/2025)

Frequently asked questions

What is the anticipated launch date for CCBHC?

We've been directed to launch no later than fiscal year 2027 in the newest proviso language. Our current path forward will be applying for a planning grant in December 2024, a demonstration in December 2025, with hopes to launch between July 2026 and January 2027.

Where can I find help on the Financial Information Request (FIR)?

Attend the meetings, watch the recordings, and review the resources on this page.

When will proviso-funded payments from the $5,000,000 for CCBHC bridge funding go out?

Funding was disbursed in August 2024. Review the timeline for more information.

Nominating Committee

The Nominating Committee recruits and selects members for the Cost Board’s advisory committees. Their job is to ensure an effective and appropriate mix of representation and diversity (including gender, geography, expertise, background, and qualifications) when selecting advisory committee members who adhere to the strategic vision of the board.

Meetings

All the Cost Board’s Nominating Committee meetings are public meetings. We encourage you to join us and share your input. Find upcoming meetings and more on the Cost Board's meetings and materials page.

Committee members

The Nominating Committee are volunteers from members of the Cost Board:

  • Ingrid Ulrey
  • Kim Wallace

Tribal affairs

The Office of Tribal Affairs' (OTA) role within the Health Care Authority is to support, strengthen, and honor our state’s government-to-government relationship and unique partnership with Tribes. OTA works to ensure Washington state recognizes and protects the interests, rights, and sovereignty of Tribal Nations for the provision of health care for their Tribal members.

OTA guides HCA work alongside Tribes and other partners to support the health and well-being of American Indian and Alaska Native people. Some of this work includes:

  • Health care coverage options
  • Mental health and substance use disorder prevention, treatment, and recovery support
  • Crisis services
  • Transitional care planning
  • Peer counseling

In addition, we partner, convene, facilitate, create policies and programs, train, support, and oversee agency efforts related to Tribes, Urban Indian Health Programs, Indian health care providers, and Tribal-serving organizations.

How do I?

American Society of Addiction Medicine (ASAM)

The ASAM Criteria defines the treatment criteria and levels of care for the treatment of substance-related and co-occurring conditions. The ASAM Criteria structure is the underlying framework for our service codes (billing guides), fiscal assumptions (rates), etc.

Under state law, licensed behavioral health agencies (BHA) providers are required to use The ASAM Criteria. Managed care organizations (MCOs), behavioral health administrative services organizations (BH-ASOs) contracted by the Health Care Authority (HCA), and private insurance plans use The ASAM Criteria as a utilization management tool.

The ASAM Criteria, 4th Edition, Volume 1, Adults and Volume 2: Adolescent and Transition Age Youth (ATAY) is now available.

Want to stay up to date on the ASAM?

4th edition timeline

SB 5361 passed in the 2025 legislative session, delaying the adoption date until January of 2028.

Read the ASAM adoption readiness FAQ

While the adoption date is delayed, clinicians are encouraged to continue to work on quality improvement.

Information about ASAM trainings

HCA in partnership with Train for Change offered comprehensive free trainings for providers between July 2024 and June 2025. While the state does not anticipate receiving funding for additional training, we appreciate everyone who took the time to participate in past trainings.

As of 2026, the state will communicate any instance of refresher courses and/or resources. There will be ASAM Technical Assistance support pre and post implementation. Please look for quarterly communication updates.

External training resources

Train for Change

Train for Change offers open training classes for individuals. Visit Train for Change open events for fees and scheduling.

The American Society of Addiction Medicine

ASAM 4th Edition resources

ASAM video trainings

The following trainings are available on YouTube. CEUs are not available for prerecorded trainings.

Vision

The Public Employees Benefits Board (PEBB) Program provides a variety of vision plans for PEBB employers, except medical-only employer groups.

Plan availability

Standalone vision plans offered by the PEBB Program are available to all benefits eligible employees whose employer offers the full benefits package.

Effective January 1, 2025, routine vision coverage is separate from medical coverage.

Before selecting a plan or provider, employees should compare vision plans to find out what services are covered, which providers are in-network, and the costs for care.

What do the vision plans cover?

  • Each plan will have a network of providers that offers services like routine eye exams, eyeglass frames and lenses, contact lenses, and discounts on treatments like LASIK.
  • All plans will offer private practice optometrists and ophthalmologists in Washington State and nationwide, but each plan’s network will include different providers. These plans were chosen to cover as many counties in Washington as possible, but not all plans will have network providers in all areas.
  • In addition to private practice locations, each plan will offer a selection of retail locations, such as Costco Optical, Walmart, Sam’s Club, America’s Best, Visionworks, LensCrafters, Pearle Vision, and Target Optical.

PEBB Program vision plans

Cost for vision coverage

The cost for vision coverage is included in the total rate, paid by the employer for eligible employees of state agencies and higher education institutions. PEBB Participating employer groups determine what portion of the rates eligible employees pay. Find your organization's PEBB Program rates.

Davis Vision by MetLife

Davis Vision is underwritten by the Metropolitan Life Insurance Company (MetLife).

Plan documents

Preauthorization criteria

Preauthorization is when a covered individual seeks approval from their health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. Preauthorization is not a guarantee, however, that the plan will pay for those services, supplies, or drugs.

Davis Vision preauthorization criteria

These criteria do not imply or guarantee approval. Please check with the plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

Find a provider

Visit the Davis Vision provider directory.

Contact information

Phone: 1-877-377-9353 (TTY: 1-800-523-2847)
Online: Davis Vision

EyeMed

EyeMed Vision Care is underwritten by Fidelity Security Life Insurance Company (FSL).

Plan documents

Preauthorization criteria

Preauthorization is when a covered individual seeks approval from their health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. Preauthorization is not a guarantee, however, that the plan will pay for those services, supplies, or drugs.

EyeMed Vision Care preauthorization criteria

These criteria do not imply or guarantee approval. Please check with the plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

Find a provider

Visit the EyeMed Vision Care provider directory.

Contact information

Phone: 1-800-699-0993 (TTY: 1-800-699-0993)
Online: EyeMed Vision Care

MetLife Vision

Plan documents

Preauthorization criteria

Preauthorization is when a covered individual seeks approval from their health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. Preauthorization is not a guarantee, however, that the plan will pay for those services, supplies, or drugs.

MetLife Vision preauthorization criteria

These criteria do not imply or guarantee approval. Please check with the plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

Find a provider

Visit the MetLife Vision provider directory.

Contact information

Phone: 1-855-638-3931 (TTY: 1-800-428-4833)
Online: MetLife Vision

Member ID cards

Once a member is enrolled in vision, no matter what the carrier/plan, members are sent a welcome packet that includes two copies of an ID card with the subscribers name.

Welcome packets also include instructions on how to set up an online account, where members can download and print additional copies of cards, access forms, and check eligibility and benefits.

Members do not need to present an ID card in order to receive services. In-network providers have access to secure portals to look up eligibility and benefit information based on the subscribers name.

Apple Health Expansion

Revised date
Purpose statement

Apple Health Expansion (AHE) is a state funded, capped enrollment (limited enrollment due to funding) program for individuals who do not meet the citizenship or immigration status requirements of other Apple Health programs.

Who may be eligible?

  • Washington residents aged 19 or older,
  • Have countable income at or below 138% of the federal poverty level (FPL),
  • Do not qualify for other Apple Health programs based on immigration status,
  • Are not pregnant or did not have a pregnancy end in the last 12 months, and
  • Are not eligible for qualified health plans with advance premium tax credits (APTC), federally funded medical assistance programs.
  • Are not eligible for another Apple Health program

What is the financial eligibility for AHE?

There are no resource limits for the AHE program. Clients will need to have income at or below 138% of the FPL. For the current FPL income standards by household, visit the Apple Health Expansion program webpage.

How to apply

Individuals who are 65 or older apply through the Department of Social and Health Services (DSHS)

Individuals who are under the age of 65 apply through Washington Healthplanfinder (HPF)

For more information, visit the Apple Health Expansion program webpage.

Both the Health Care Authority (HCA) and DSHS will process AHE applications. Clients aged 19-64 will be automatically processed in HPF (and all other acceptable application pathways) giving either an approval or denial based on the attested information of the client. For individuals aged 65+ DSHS will process their application coming through Washington Connection and all other acceptable application pathways and give either an approval or denial based on the confirmed information of the client.

What if the cap is on?

If the CAP is on, with EPICS approval, HCA and DSHS may manually process and approve applications for AHE.

HCA – MAGI Apple Health Expansion (AHE) worker responsibilities

HCA processes AHE applications under MAGI when:

  • Individual is age 19 through 64.
  • Individual is not eligible for Medicare, or any other federally funded Apple Health programs, and follows MAGI rules established through the Healthplanfinder.
  • If AHE has open availability individuals will be approved if they meet all eligibility requirements for the program.

Processing the application manually due to CAP being on

  1. Review the individual's income and immigration status to ensure they are not eligible for any other federally funded MAGI programs.
  2. Is the client eligible for Apple Health Expansion based on attested information:
    1. If yes, continue with manual application processing
    2. If no, sends denial letter (If one has not already auto generated from HPF Dashboard) for AHE.
      1. Did client mark AEM? If yes client will be reviewed for AEM eligibility
  3. If client is determined eligible for AHE staff manually approves client and sends approval letter.

"Submit information" letter

If attested income does not verify, verify important deadline to submit information letter generates.

Immigration status

If attested immigration status does not match information on file (i.e. attests to no immigration status but there is information on file, or attested immigration status does not verify), follow SAVE verification procedures.

Clarifying information

Clients who are Federally Qualified (FQ) or Non-Federally Qualified (NF) are not eligible for AHE.

Clients who have not yet met their five-year bar are not eligible for AHE. This is due to being eligible for Qualified Health Plans with Advance Premium Tax Credits. These individuals could also be looked at for Alien Emergency Medical (AEM).

There are no retro benefits for AHE. If retro is requested staff may look at AEM for retro months.

AHE does not include long-term services and supports (LTSS) authorized by the Developmental Disabilities Community Services (DDCS), Aging and Long-term Supports Administration (ALTSA), or Home and Community Services (HCS) in the scope of care benefit package.

Clients also currently active on Medical Care Services (MCS) coverage are not eligible for AHE coverage as they would be dual-enrolled in coverage.

Classic Apple Health Expansion Worker responsibilities

Classic AHE applications are only processed by Community Services Division (CSD) specialized staff.

If the program cap has not been met, clients will be approved if eligible. If the limit (cap) is at capacity, eligible clients will be denied. Clients may qualify for other coverage including Alien Emergency Medical (AEM) and can purchase a QHP plan through the Health Benefits exchange (HBE).

DSHS-Classic Apple Health Expansion (S20)

DSHS-CSD processes AHE under Classic Apple Health when the individual is age 65 or older.

The following immigration status’ are eligible for AHE:

  • Undocumented / No immigration status
  • Applicants for asylum
  • Applicants for withholding of deportation/removal
  • Registry applicants
  • Order of supervision
  • Applicant for cancellation of removal / Suspension of deportation
  • Expired or revoked immigration status

Household composition-AHE (S20) will follow the same household composition rules as S02:

  • Income: Countable Earned and Unearned income types are the same as S02/S07 medical.
  • SSI recipient spouse: If an AHE applicant is married and their spouse is an SSI recipient, they are not eligible for AHE.
  • When there are two applying spouses on the same AU and they're eligible for different programs, only one spouse will be approved for coverage on the AU.

Example

  • John and Beth apply for medical on 7/1/26.
  • John is a 70-year-old citizen and Beth is 65 and does not have legal status.
  • A worker screens in S02 for John and S20 for Beth, with both clients having financial responsibility Applicant (PN).
  • During Finalize the S02 is approved for John with certification 7/1/26 - 6/30/27.
  • Beth's financial responsibility is changed from Applicant (PN) to Ineligible Spouse (SP).
  • During the finalize for the S20 John would be ineligible spouse (SP) and Beth would be applicant (PN).
  • If there is a spot available and Beth is eligible, she would be approved S20 on AHE.

Enrollment CAP

  • The CSD specialized medical team has cap override access in ACES. This field is displayed on the AU details screen in ACES 3G
  • All S20 requests processed after the cap has been met shall be denied for Reason Code (171) Enrollment Cap regardless of the date of application or when it was received as long as the AEM indicator = N and they aren't eligible for a Classic Medical Program. (Trickle to pending AEM if AEM indicator = Y.)

Asset Verification System (AVS)

  • S20 is not subject to asset test and therefore is required for AVS. S20 clients and AUs will not be included in the AVS application file. However, the AVS authorization field will display in ACES 3G when S20 is screened. If you have AVS authorization, update this field, if you do not, you are able to bypass.
  • AVS authorization field displays because if S20 trickles to S07. AVS authorization is required for S07 approval.

Submitting an application

DSHS Classic Apple Health Expansion

  • Staff screen in the application and can select the program code (S02, S20). Based on information entered in ACES, the program will trickle to the appropriate program.
    • Example: S02 is screened, but client is eligible based on immigration status and income for S20- ACES will trickle to S20
    • Example: S20 is screened, but based on immigration status and income entered the client is eligible for Federal Medicaid. S20 trickles to S99.

Attestation acceptance

Client attestation of all eligibility factors will be accepted.