Most medical insurance plans don’t cover dental or routine vision. Therefore, you are usually given an option for signing up for those benefits as a separate entity. However, unlike a dental or prescription drug plan, the vision is usually the one that is most left in the dark. It can also be slightly difficult to interpret. Here are a few key things to keep in mind when choosing a vision benefit plan that is right for you and becoming familiar with your new plan.
1. Become informed with the proper name of the Vision insurance company.
Often times, the name of your Vision insurance plan is not the same name as your medical carrier. Although, you may only be issued a card for your medical plan, an entirely different insurance company may be administering your vision benefits. Some Vision carriers don’t give out separate identification cards, leaving you unsure of what insurance company information you should give when calling to set up an appointment. For example, your medical benefits may be through Blue Cross Blue Shield or Aetna, while your Vision may be through VSP or Eyemed. If it is an available option, you can call your vision benefit administrator and request a card, print out one from their website, or just simply write down the name of it on the back of your medical/dental insurance card. Giving the proper name of your vision benefits administrator helps the office staff to collect your accurate co-pays and gather your proper benefits to ensure that you are getting all the benefits that you are entitled to.
2. Know the difference between a funded benefit plan and a discount plan.
A funded benefit usually offers the eye health exam at a low co-pay and gives an allowance amount for you to use toward glasses or contact lenses. For example, you may be entitled to $200 you can use toward glasses within the calendar year. Since a benefit plan offers the most savings to you, the benefit is usually only offered as a one time use throughout the year (depending on the benefit frequency). Besides the savings, another upside to a benefit plan is the extended coverage that may be offered for unique situations. For example, coverage for early replacements of lost glasses or medically necessary eyewear for certain eye conditions, such as Keratoconus.
A discount plan usually has a lower premium, so in turn, offers lower savings at time the time of your visit. It guarantees you a percentage off the practice’s retail price for exams and eyewear. For example, you may be entitled to 20% off retail price of exam and 30% off retail price of glasses. On the other hand, most discount plans don’t put a cap on how often you can use these discounts throughout the year. Knowing the difference can help you calculate your savings from the actual benefit versus your savings from the higher/ lower premium.
3. Know your vision benefit frequency.
Find out if your benefits are reset every calendar year, or by last service date. Also, unlike most medical insurance plans, Vision plans often don’t require you to meet a deductible. So, the benefit frequency doesn’t necessarily follow that of your medical plan. Knowing this will help you better plan out how to make the most of your benefits and allowances.
4. Know your physician network for both Vision and Medical.
A routine exam is what you will use your vision benefit for. However, a visit to treat pink eye, glaucoma testing, and even cataract surgery would be considered medical. Although it may seem absurd, the physician that may be on your Vision panel of doctors may not always be within your medical network panel. So be sure to coordinate accordingly to minimize any out of pocket expenses, should you ever need to have a medical eye visit.
** This is not an exact quote of the insurance plans named above. Each plan is subject to their own contracted amounts. Please check with your insurance plan for an accurate benefit quote.**