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Eye Chart

Vision & Eye Care Plans

What is covered under a vision plan?

Most Vision plans will cover the cost of an eye exam, but what is not commonly known by many is that many types of eye examinations can be covered by health insurance providing that the exam is medically necessary.  Why the confusion then?  Typically most health insurance plans exclude coverage for eye exams relating to the prescription of glasses.  In other words, the trip to the optometrist is generally excluded from a health insurance policy.  

What’s the difference between vision plans?

Besides covering the cost for the initial and/or annual eye exam vision plans may offer discounts on frames, contacts, laser eye surgery, and lenses.   The amount of reimbursement for the hardware, and how frequent the plan will pay for replacements usually sets one plan apart from another.  

In-Network vs. Point of Service Plans

Another major factor in choosing a vision plan is the size of the network and any accessibility outside the network of providers.  An HMO, health maintenance organization, a term usually associated with health insurance, is commonly used to reference the providers of a vision plan–-in other words, a managed care plan of in-network providers.  A POS, or point of service, another term used with health insurance, would be used  to describe a plan that allows members to access providers outside the network.  There are other terms and features of a vision plan that would affect the rates and the value such as the types of hardware covered,  the deductibles, coinsurance, and/or maximum limits.  

How are vision plans sold?

Many vision plans are packaged with other products such as a group health or dental plans.  If it sold as separate benefit it may be offered through an employer group as a voluntary benefit or can be offered as an involuntary benefit.  

Voluntary plans are typically paid either partially or fully by the employee, hence the plans would be contributory.  Generally the plans cost more than involuntary plans as there is usually a greater percentage of utilization due to adverse selection.  Many times, employees that have vision needs tend to elect coverage and those that do not opt out causing the loss ratio to be greater proportionally than a group with both classes combined.   

Involuntary plans are either package with other lines, with all employees choosing the parent line automatically covered or paid in its entirety by the employer.  If the employer pays the premium, than the plan would be considered non-contributory with respect to the employee as the employee is not contributing to the premium.     

By William F. Schaake, CIC, CRM © 2011 All rights reserved

Employer Group Sponsored Vision Plans  

Some of the Carriers We Represent

VSP -First Rehab - Co-Health

Aetna - Cigna - Guardian - UHC

Aflac - Colonial Life  - OBM

Key Terms

Eyeglasses - Frames - Contacts

Optometry - Optometrist

Ophthalmology - Ophthalmologist

Single Vision - Bifocal - Trifocal

Lenticular - Lasik Eye Surgery

Spherical - Toric - Multifocal

Gradient Tint - Photochromatic

Hi-index - Polycarbonate

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