HomeVision InsuranceBenefits
By Amy Hellem; reviewed by Gary Heiting, OD
The term "vision insurance" is commonly used to describe health and wellness plans designed to reduce your costs for routine preventive eye care (eye exams) and prescription eyewear (eyeglasses and contact lenses). Some vision plans also offer discounts on elective vision correction surgery, such as LASIK and PRK.
But unlike major medical insurance policies that may provide unlimited benefits after a certain co-pays and deductibles are met, most vision insurance plans are discount plans or wellness benefit plans that provide specific benefits and discounts for an annual premium.
In effect, these vision discount and wellness benefits plans offer savings much like a gift card. As such, they can be used to cover much of the cost of basic eyewear, or they can be used to make premium eyewear products and enhancements — such as progressive lenses, anti-reflective coating and photochromic lenses — significantly more affordable.
When purchasing "vision insurance," be sure you fully understand the costs and benefits associated with the plan(s) you are considering. Also, if you have vision care coverage through a plan at work, be aware that "vision insurance" plans usually operate differently than other health insurance plans or major medical insurance.
It's always a good idea to ask the business staff at your eye doctor's office to advise you of the specific benefits of your vision plan prior to your exam and eyewear purchase so there are no surprises afterward.
That said, we will use "vision insurance" in this article as a general term to cover wellness and discount plans that offer vision benefits, as well as more traditional health and medical plans that include vision benefits as well as coverage for eye conditions and diseases and treatment of eye injuries.
Where can I Get Vision Insurance?
Group vision insurance can be obtained through your company, association, school district, etc., or through a government program such as Medicare or Medicaid.
If you are not eligible for a group plan because you are self-employed or for other reasons, most vision insurance providers also offer policies that you can purchase individually.
Vision insurance often is a value-added benefit linked to indemnity health insurance, health maintenance organizations (HMOs) and preferred provider organizations (PPOs) that have contracted with managed vision care networks to provide eye care services.
Indemnity health insurance is traditional health insurance that allows policyholders access to medical providers of their choice.
An HMO is a group of healthcare providers — doctors, laboratories, hospitals and the like — employed to provide health care to plan members at discounted rates. Usually, plan members are required to access health care (including vision care) only from HMO providers.
A PPO is a network of healthcare providers organized to provide healthcare services to health plan members at a fixed rate below retail prices. Plan members may opt to access out-of-network providers, but usually at a greater cost.
When you buy vision insurance, you receive the following benefits:
Access to a network of providers, including optometrists and ophthalmologists, eyewear stores, optical laboratories and LASIK surgeons
Routine, preventive eye care services at reduced rates
What kinds of vision insurance plans are available?
Vision insurance typically comes in the form of either a vision benefits package or a discount vision plan.
Typically, a vision benefits package provides free eye care services and eyewear within fixed dollar amounts in exchange for an annual premium or membership fee and a relatively small co-pay (fixed dollar amount) each time you access a service.
A discount vision plan, on the other hand, provides eye care and eyewear at discounted rates after you pay an annual premium or membership fee.
In some cases, a vision benefits package or discount vision plan may also include a "deductible" — a fixed dollar amount you must pay your eye care provider out-of-pocket before the insurance benefits take effect.
Both kinds of vision insurance can be custom-designed to meet the requirements of a wide range of customers, including school districts, unions, and big and small companies.
Vision plans generally cover or provide discounts on the following products and services:
Annual eye examinations
Eyeglass frames
Eyeglass lenses (including lens coatings and enhancements)
Contact lenses
Discounted rates for LASIK and PRK
Also, reputable vision insurance providers should have quality assurance and member satisfaction services to answer your questions and help you resolve any disputes or issues you have with an eye care practitioner in your plan's network.
SEE RELATED: Where can I buy vision insurance?
What does vision insurance cost?
Vision insurance costs vary, depending upon how the program is designed. Costs also may vary based on your state of residence.
As a general example, Vision Service Plan (VSP), the largest vision plan provider in the United States, lists the following cost savings associated with a typical VSP vision plan for individuals, compared with purchasing an eye exam and eyewear without vision insurance.
NOTE: Benefits associated with VSP plans vary from plan to plan. Most plans also include benefits for purchasing contact lenses — either as an alternative to glasses or in addition to them, depending on the plan. For more details and specifics about your own VSP benefits (if covered) visit vsp.com or speak to your HR representative at work.
| Savings Example | What You Pay Without Insurance | What You Pay With VSP | You Save |
|---|---|---|---|
| Eye exam | $163 | $10 co-pay | $153 |
| Eyeglass frames / single vision lenses | $150 / $90 | $25 co-pay | $215 |
| Anti-reflective coating | $113 | $69 | $44 |
| Photochromic lenses | $109 | $70 | $39 |
| Polycarbonate lenses | $57 | $31 | $26 |
| Annual premium for VSP plan (employee only) | -0- | $90 | -$90 |
| Total | $682 | $295 | $387 |
| Comparison is based on national averages for comprehensive eye exams and most commonly purchased eyewear brands. Chart represents typical savings for VSP members when they see a VSP eye doctor. Plan above may not be available in all states and plan costs vary by state. Data published at VSP website; accessed January 2017. | |||
It's a good idea to comparison shop several vision insurance providers to make sure you get the best value for the eye care benefits you desire.
Typically, you pay for group vision insurance through payroll deductions or flexible spending accounts (FSAs).
An FSA, sometimes called a cafeteria plan, allows an employee to use pre-tax dollars to purchase selected health benefits such as vision insurance. You save money because you pay for the policy with income that has been set aside for health costs and is not subject to taxation.
If you purchase an individual vision insurance plan because you are self-employed or your employer does not offer vision insurance, you can expect to be billed monthly or annually.
Madeleine Vessel also contributed to this article.
Page published on Wednesday, February 27, 2019
