Tips to Help Your Employees Navigate Vision Plan Options
Name a vision exam, and I’ve probably been through it. I wore glasses or contacts from age 3 to age 26. I had an astigmatism, wore an eye patch, was treated as a glaucoma suspect, and eventually had LASIK. I’ve seen it all. But, my experience was mostly through the lens of a dependent patient, not the parent stuck with the bill. Once I started driving myself to my appointments, my mother would hand me a $20 bill to pay. I always assumed that was just the cost of an eye exam. I had no clue what a copay was.
When I started my career in benefits, I realized how much I didn’t know. All benefits can get complicated, and a vision plan is no exception.
Here are some tips you may want to consider including in your Vision Care Benefits communication to help your employees go into open enrollment with eyes wide open.
Understand the Vision Plan Network
Determine if your network is geared more toward doctor offices (like VSP is), or toward retailers (like Davis Vision is). If it’s important for you and your family to see a specific provider, check your carrier’s website to see if your provider is in-network. If not, it may still be reasonable to have your exam at your out-of-network provider and purchase lenses and frames from an in-network retail provider. So, how do you determine that?
Understand the Vision Plan Coverage
First, do you know when your coverage begins? Confirm the effective date and whether there is a waiting period for you or your dependents to become eligible on the plan, depending on when you enroll. Once you’ve done so, look at what benefits are most important to you and their associated pricing:
- Exams: Typically, there is a small copay or the exam is included at no additional cost. Many medical plans have coverage for annual vision exams, as well.
- Materials: After a small copay, different materials are handled in different ways.
- Eyeglass Lenses: Often, standard and certain types of specialty lenses are covered in full by the copay. However, these days, there are many different types of lenses. If you know that you wear bifocal, polycarbonate, tinted, or other specialty lenses, do not assume that these enhancements are covered the same way as single vision plastic lenses. Certain lenses may only qualify for a retail discount, which may or may not be worth the plan premium to you.
- Contact Lenses: As with eyeglass lenses, certain types of contacts are treated differently in most plans. Many plans allow contacts to be covered in full in lieu of standard eyeglass lenses, or provide a substantial discount. Your plan may also offer a discount for daily disposables or specialty contacts. There are other expenses unique to contacts to consider. Your copay or allowance for lenses may look like enough to cover your contacts, but don’t forget to verify if the contact-fitting or follow-up appointments count toward your allowance or have a separate copay.
- Frames: Usually, you get an allowance, and then a discount for amounts over that allowance. Do you wear designer frames? Many carriers have partnerships with certain designer brands to provide further discounts or rebates to help bring down the high cost of fashion! These discounts can add up, but don’t expect your plan to foot the bill for anything too special.
- Frequency: Most plans allow new lenses (eyeglass or contact) and new frames either every 12 or 24 months. Frames and lenses are often covered at differing frequencies.
- Laser Surgery Discount: Many plans provide a discount (usually 5% to 25%) for LASIK, PRK, or other laser eye surgeries. These discounts usually apply to in-network providers. Start by speaking with your doctor to determine what option is best for you. Find providers who perform these consultations and surgeries and reference your provider network to see if there’s a Vision plan with the right fit.
Carriers offer wide varieties of plans, and each carrier provides different additional benefits, but if you’ve got the major points down, you’re already ahead of the game.
If you offer your employees a benefits decision support tool, be sure it includes the ability to assist with more than just medical benefits and that it provides personalized recommendations. Allowing employees to learn more about their vision plan (or dental, health savings accounts, voluntary benefits, etc) and giving them a data-driven tool to run specific spending scenarios will help them make better benefits choices.
If you don’t have a benefits decision support tool or it isn’t providing the complete support and education your employees need, check out our Tango Decision Assist Benefits Communications Platform or request to see a demo.
Categorized in: Benefits Communication & Decision Support