Each vision insurance plan offers different levels of coverage, starting with basic eye healthcare and wellness needs such as vision exams, prescription glasses, and contact lenses, usually performed by doctors and care providers within the network. More comprehensive plans may also provide discounts for elective surgical procedures such as LASIK vision correction, additional allowances for out-of-coverage providers and health professionals, or lens enhancement alternatives for prescription glasses.
Standard exclusions include eye exams given during a hospital stay, contact lens exams, prescriptions, elective corrective procedures such as LASIK and PRK, light-sensitive lenses, vision therapy, lens tints, and replacement of lost or stolen prescription eyewear; though these may all be available as optional policy riders.
Types of Vision Insurance
Vision insurance, though typically offered as a value-added benefit connected to an existing health insurance plan, can also be purchased as a stand-alone discount plan. This last option is the simplest type of plan, as it usually works as a flat discount (commonly between 15 and 30%) for vision services such as routine eye exams, some surgical procedures, and prescription eyewear. After the discount has been applied, policyholders are responsible for paying the remaining cost of the service. These plans offer the advantage of low insurance premiums and are therefore a good option for consumers on a budget.
The other available option is incorporating vision care as a benefit plan that acts as a rider to your existing health insurance coverage. Vision benefit plans usually take the form of preferred organizations (PPOs), or health maintenance organizations (HMOs). PPOs have a specific network of eye doctors you are allowed to use, which charge a fixed rate below retail prices; if you go out-of-network, costs are usually substantially higher. HMOs only allow their customers to access care from within their network of healthcare providers to access their discounted rates. In any case, both HMOs and PPOs provide eyewear and eye care at discounted rates, for an annual premium or membership fee. In some cases, customers must also pay a small deductible or fixed dollar amount before the insurance will start coverage.
When considering the costs involved with vision insurance, it is important to make a note not only of the services you need, but the frequency with which your plan allows you access. If you are choosing between a benefit plan and a discount plan, it is essential to compare the actual costs of the services you need, and which type of plan is most likely to offer you more considerable savings. Coverage and payments can vary significantly between plans, and it can be structured considerably different to regular health insurance.
Any reputable vision insurance plan should offer easy ways to contact them, either over the phone, via email, or live chat online. It is also essential to check whether the plan has a waiting period between the moment of purchase, and when the coverage begins. Incidents, which occur during waiting periods, are not claimable.
Helpful Information about Vision Insurance
Vision insurance and vision plans are designed to help customers with vision issues reduce the cost of their eye care and prescription eyewear, covering prescription glasses, contact lenses, and eye exams, etc. However, regular vision checkups can also detect a whole host of hidden medical problems, though people with poor vision, a family history of eye disease or a condition that may exacerbate vision problems (like diabetes), should also have frequent exams.
Usually referred to under the term vision insurance, vision plans more accurately function as stand-alone annual wellness benefits or discount plans, except in the case of medically necessary eye surgery, which usually falls under general health insurance coverage. It is important to note here that eye care for children is considered an essential benefit under the Affordable Care Act, but adult healthcare is not required to include vision plans. Basic services are usually limited to eye examinations with dilation, one eyeglass frame and pair of lenses, and possibly a pair of contact lenses. Refractive surgery such as LASIK or PRK may also be included. Value-added options, such as progressive, high-index, photo-chromic, or polycarbonate lenses, are also typically available, as well as anti-reflective or scratch-resistant coating, and polarized sunglasses.
When evaluating different vision plans, it is crucial to determine which provides the benefits and discounts that best meet your specific needs, which will save you the most, and whether it has quality assurance mechanisms and simple claims procedures. Also, remember that even if one of the options above is not included and must be paid for out-of-pocket, you may still find that the components that are covered result in a significant reduction of your overall cost.