Insurance, HRA, and Your Eyes – What You Need to Know

December 03, 2019

As the year draws to a close, you need to take stock of your insurance benefits to make sure you get the most out of your plan. It’s common to see even the most organized people leaving unused insurance benefits on the table – but you want to make sure it doesn’t happen to you. If you have medical insurance, a vision care plan or an HRA, you need to act quickly to make sure you get the maximum value out of the premiums you pay. 


First of all, it’s important to understand the difference between how vision care plans and your medical insurance can cover services at your optometrist’s office. Vision care plans are add-on policies that are sold in addition to your medical coverage. A vision exam could be covered by one plan or the other, depending on what happens during the appointment.  


If everything goes well and the exam doesn’t involve a medical diagnosis requiring treatment, it is called a routine vision examination, and it will be covered by your vision savings plan, usually once per year. However, if an issue is addressed during the visit, your medical plan could be responsible for covering any charges. Typical diagnoses your medical coverage will accept include eye infections, floaters, styes, dry eye, glaucoma treatments or a loss of vision caused by a medical condition of the eye. Injuries to the eye and similar emergencies are also typically covered by a medical plan. Your eye doctor can tell you which of your plans will be responsible for covering your visit. Your medical plan will not cover a vision test that determines what your prescription will be if you need to have your vision corrected; this is called refraction, and is only covered by your vision care plan. 


If you’re interested in wearing contact lenses, many vision care plans don’t pay for the contact lens portion of an eye exam, but instead will offer a discount on this service. 


Your employer may also offer a health reimbursement arrangement, or HRA. In an HRA, your employer agrees to give you a set amount of dollars each year that can be used to reimburse you for the out of pocket costs of health care. In effect, this is “free money” that your employer provides to you. Some HRA plans allow you to “roll over” unused portions of this gift to the next year, while other plans require you to completely drain the fund each year. Any funds not used by the end of the plan year will be forfeited. It’s critical to know if your plan allows you to bank funds from one plan year to another before the current year ends.  


Employers may also allow employees to set up a flexible savings plan, or FSA, that allows employees to set aside a percentage of their pay tax free to cover healthcare costs. This election must be used in full each year; any remaining funds in the account when the plan year ends will be forfeited. You want to review your HRA and FSA balances now to see if you need to “spend down” any funds that will disappear at the year’s end. If you find you have money in these plans that will vanish in just a few weeks, consider stocking up on contact lenses, buying prescription sunglasses or picking up a spare pair of glasses with trendy designer frames. 


Don’t let your vision care benefits expire! Call Pro-Optix Eye Care today at 713-360-7095 to schedule an appointment with one of the Tanglewood/Galleria Area’s leading optometrists – we can help you find creative ways to look forward to the New Year! 


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