Vision Coverage Information

Vision Insurance or Vision Plans are a common part of company benefit packages. While they come in a huge variety of different “flavors” most have several common traits.

Routine Eye Exams

At the core of most vision coverage is a yearly routine eye exam. This is the exam where your eye doctor (optometrist or ophthalmologist) puts you through a series of tests for common eye problems such as glaucoma, checks to see if you need corrective lenses and what strength, and usually dilates the pupils to look at the health of the inner eye.

If you are already experiencing some kind of ocular (eye-related) problem, this falls in the realm of your medical insurance. The same would be true of an accident of some kind that involved the eyes. The confusion can come when a routine eye exam uncovers a medical issue. The initial exam would be covered under the vision plan, but if a problem is discovered, all the visits after that fall under medical coverage.

Coverage for Frames and Lenses

Most vision plans have some type of coverage for frames and corrective lenses. The amount of coverage varies tremendously. Many vision plan rates were written over twenty years ago and not updated often, so you may find your frame coverage will get you a pair “Clark Kent specials” and nothing more.

Lens coverage tends to cover the most basic type of lenses, with no extras like scratch guard, beveled edges, tinting or anything of that sort covered. Likewise, the rates often do not take into consideration the strength of the prescription. There may be extra coverage for bifocals, or trifocals.

Contact Lenses

Many vision plans also have some type of coverage for contact lenses. As disposable lenses have become the norm over long term wear contacts, that component of coverage has become even more variable than that for frames and lenses. Some will pay for only the long term wear contacts, some will pay for a certain quantity of disposable lenses per month or per year.

How Vision Coverage works

While there are many variations, vision plans generally fall into one of two categories: the claim type or the discount plan type. The claim type of plan is set up to work very much like medical insurance. When you visit the doctor, or pick out glasses, an actual claim is filed with your insurance carrier and is subject to whatever the terms of your plan are. An attempt to discuss all the variations of vision coverage would be a term paper length article. Plans vary from paying an entire exam and glasses or contacts to paying a token amount and everywhere in between. Some vision plans have networks of preferred providers who will give you better rates, others don’t.

A discount plan is similar, but no claim is filed. The plan simply gives you a discount off frames, lenses or contacts. Depending upon the company, the contract and whether the provider is part of their network, the discount can be very substantial.

Hybrid plans encompass a little of both a claim is filed for the actual eye exam, but the frames, lenses or contacts are on a discount plan.

What vision plans generally don’t pay for:
Any type of surgery, including LASIK ( there are exceptions)
Any type of medical eye problem dry eye, glaucoma, diabetic retinopathy, etc.
Accidents involving the eye

As you can see, Vision insurance is not a simple topic. Its variations are as broad as the number of companies who offer it. If you have vision coverage as part of your insurance package, read all the materials that came with your coverage, and if you still have questions, don’t hesitate to call the provider, or discuss them with your human resources department.