January 30, 2019
Whether your vision savings plan is provided by your company-sponsored health plan or you purchase it on your own, it can be difficult to make sense of it. Like most insurance policies, vision care plans can be hard to understand if you aren’t familiar with the way they are written. To make things a little easier, we’re offering a crash course on some of the key terms and items to pay attention to when you’re going over your policy.
First, always read your policy completely before making an appointment with an eye doctor. Your plan may require that you visit a provider included in a list of approved doctors, called a network, or need a prior authorization.
Almost all vision savings plans cover a comprehensive vision exam, usually once per year. Most MEDICAL insurance plans also cover a comprehensive vision exam per year. Some plans may differ, so it’s important to note how often you can have a vision test. The exam may require a copay, which is a set dollar amount due to the provider at the time of the service. The copay usually varies according to the individual plans, with most ranging between $10 and $35. Be prepared to pay this amount on the day of your eye exam.
Vision savings plans also reduce the cost of vision correction, allowing certain amounts toward the purchase of eyeglasses and contact lenses. Some plans may contribute towards vision correction surgery such as LASIK, which is not covered under standard medical insurance. If LASIK is something you’re looking for, be sure to review any plan carefully to make sure it’s covered under the terms of the policy before enrolling.
It’s important to review the limitations and exclusions when buying glasses and contact lenses under the plan. This part of the policy is where you’re likely to see the most variation. Most plans break down the savings by category, assigning contribution towards frames, lenses and contacts individually.
Frame benefits often depend on what type of frames they are. Insurance savings plans may endorse specific brands of frames and offer greater contributions on these units, while certain brands of frames may be excluded from coverage altogether. Some vision savings plans will give an additional discount – 20%, for example - on the remaining cost of a frame that exceeds the contribution under the plan. Designer frames may cost more, and if your plan offers an additional discount on top of the contribution provided for frames, taking advantage of it can stretch your eye care budget.
Vision plans typically offer benefits on one pair of lenses per year. Copays – similar to those for eye exams – may apply, and if they do, the amounts may vary depending on the type of lens you require. For example, a copay on single-vision lenses may be $50, while the copay for progressive lenses may be $150. Additional copays may be applied for scratch resistant lenses or lenses made from specific materials.
If you’re considering contact lenses, scan your plan for differences in reimbursement for both eye exams and the lenses themselves. Most vision plans have different allowable amounts for glasses than for contact lenses. Your plan may contribute additional dollars to help with the cost of contact lens eye examinations, which also include fitting and training in the care and handling of lenses. The copay for a contact lens exam may be higher than one for glasses.
If you’re still uncertain of the best way to use your eye care benefits after reading your policy, stop in to Pro-Optix Eye Care, your Tanglewood and Galleria Area eye doctors. We’ll take you through your vision savings plan one step at a time to make sure you make the most of your benefits.
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