The cost of routine eye exams and prescription eyewear can be of real concern, especially for large families. In many cases, vision insurance can lower these annual expenses.
A vision insurance policy is not the same as health insurance. Regular health insurance plans protect you against financial losses due to unexpected eye injuries or disease. Vision insurance, on the other hand, is a wellness benefit designed to provide routine eye care, prescription eyewear and other vision-related services at a reduced cost.
Because we provide both medical and routine eye care, we accept a number of insurance plans to help cover the cost depending on your individual needs. Here are just some of the plans that we accept:
Medical Plans We Accept:
• Horizon BC/BS of NJ
• United HealthCare
• Emblem Health/GHI
• First Health/MailHandlers
Vision Plans We Accept:
• Davis Vision
• Optum Health
We do accept other plans as well, so if you do not see your plan listed here, please give us a call and we would be happy to assist you. Our staff is also always available to answer any questions regarding your benefits.
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.
Also, as an individual, you have the option of purchasing your own vision benefit plan.
- Vision insurance is often a value-added benefit included in indemnity health insurance plans, health maintenance organization (HMO) plans and plans offered by preferred provider organizations (PPOs): Indemnity health insurance is traditional insurance, which allows policyholders to access medical providers of their choice.
An HMO is a group of healthcare professionals – doctors, laboratories, hospitals and the like – employed to provide health care services to plan members at discounted rates. Usually, health plan members are required to access health care only from HMO providers.
- A PPO is a network of healthcare professionals organized to provide healthcare services to 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.
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 enrollees eye care services in exchange for an annual premium or membership fee, a yearly deductible (a dollar amount) for each enrolled member and a co-pay (a smaller dollar amount) each time a member accesses a service.
A discount vision plan provides eye care at fixed discounted rates after an annual premium or membership fee and a deductible are paid.
Both kinds of vision insurance can be custom-designed to meet the different requirements of a wide range of customers, including school districts, unions, and big and small companies.
WHAT DOES VISION INSURANCE COVER?Vision insurance generally covers the following services and products:
- Annual eye examinations
- Eyeglass frames
- Eyeglass lenses
- Contact lenses
- LASIK and PRK vision correction at discounted rates
Generally, services acquired from network providers are cheaper than services from out-of-network providers.
WHAT ARE MY PAYMENT OPTIONS?Typically, if group vision insurance is available from your employer, you pay for it 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 receive the full benefit of income that has been set aside for health costs, making it not subject to or reduced by taxation.
If you purchase an individual vision insurance plan because your employer doesn’t offer a group plan (or because you are self-employed), you can expect to be billed monthly or annually.
UNDERSTANDING VISION PLANS AND COVERAGEThe options available to you in vision plans can be a little daunting. If you’ve chosen your vision insurance through your employer, your HR department and the insurance company literature—and websites—are a good place to start to understand what your vision insurance plan does and does not cover. In general, there are two types of vision insurance plans:
Vision Benefits PackageOften purchased as an addition to traditional employer-provided healthcare, this type of vision insurance includes a fixed set of benefits related to eye health and maintenance, such as routine eye exams and testing, discounts for corrective eyewear, even benefits that reduce the cost of eye surgery. Vision insurance like this typically includes a “network” of participating eyecare professionals who have agreed to honor the plan particulars. This type of vision insurance plan has evolved over the years to include more personalized choice for the consumer in the form of defined contribution vision coverage—where you, the consumer, choose the particular services and discount offerings based on what you expect your vision expenses to be. Many of these vision plans involve using pre-tax dollars deducted automatically by your employer in the form of Flexible Spending Accounts, “Cafeteria” Plans, Health Savings Accounts or Health Reimbursement Accounts. Each has particular tax advantages and drawbacks you should discuss in full with your vision plan administrator or provider, and if necessary, a tax professional.
Vision Discount PlansWhile similar to traditional vision benefits, this type of vision insurance is generally less flexible than a vision benefits package because it offers flat “discounts” across the board for a wide menu of vision-related services, including specified discounts on eye exams, eyeglasses and contact lenses, even many surgical procedures. You agree to pay the difference in cost in full—however these types of plans generally offer lower premiums than traditional vision benefit plans. Vision insurance like this typically includes a “network” of participating eyecare professionals who have agreed to honor the stated discounts within the vision plan, so long as you agree to pay the difference. Vision insurance planning. It may sound confusing at first, but you can “plan” to use your vision insurance to your maximum benefit by fully understanding what is specifically covered or not covered under your vision insurance plan, and by also discussing options with your eyecare professional to see how best to apply your particular vision coverage to your eyecare expenses. This planning includes fully understanding any “traditional” health insurance coverage you may have. Unexpected eye injury, or the onset of certain eye diseases and their related treatments is often covered by your traditional health insurance rather than your specific vision insurance plan. The point here is—it’s your vision insurance, your vision coverage—understanding your particular vision insurance plan is critical to maximizing those benefits.
USE IT OR LOSE ITVision insurance benefits do expire. Depending upon the type of vision insurance plan you’ve enrolled in, your vision insurance benefits may expire annually. This means if you don’t “use it” you “lose it” until the next year. Since in some way, shape or form, you are contributing your hard-earned money toward your vision coverage, there’s really no excuse to skip your annual eye exam, or get “checked out” should you experience any changes in your vision.
What’s more, many of the defined contribution vision insurance plans (using Flexible Spending Accounts or Health Savings Accounts, in particular) don’t allow for your deposited money to “roll over” into the next year. If you don’t spend what you’ve allocated, you may be at risk of losing that money entirely.
Think beyond the traditional examination—a second pair of eyeglasses, prescription sunglasses, photochromic lenses, or eyewear that’s specifically designed to fit your lifestyle. All might be within ready reach if you maximize your vision insurance coverage. Special thanks to the National Eye Institute, National Institutes of Health, for source material that aided in the creation of this website.