Understanding Vision Insurance Benefits


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Creative Commons License photo credit: nederhoed

Every vision insurance company offers different plans. Before heading to the optometrist, it is important to understand your vision insurance: what services it offers, what the costs are, and how it works. Once you know what your plan will cover, you can make an appointment with the optometrist with confidence.

Services Provided

Vision insurance typically covers the following services:

* Routine eye exams once a year

* Glaucoma testing, as part of a comprehensive eye exam

* Pupil dilation for physical examination of the eyes

* Discounts on corrective eyewear

* Discounts for laser eye surgery

* Basic lenses

* Contact lenses

Many plans allow the customer some flexibility in choosing the types of coverage that will be provided. You can choose higher or lower levels of benefits, based on what you think your annual vision expenses will be.

Costs for Services

Just as there are co-pays for visiting your regular doctor and vision insurance often has co-pays as well. Exams may be covered in full, but there is typically a small co-pay required at the time of service. Frames are usually covered at a discounted rate. Your plan will cover up to a set amount towards the frames, and you would be responsible for paying the difference. Lenses are typically covered in full for basic lenses. Extra features such as anti-glare coatings and anti-scratch coatings are not usually covered, so you would have to pay for those features. Transitions lenses are another option that many insurance companies do not pay for.

Network Providers

Every insurance company has a list of in-network and out-of-network providers. In-network providers are doctors who have an agreement with the insurance company regarding the amounts that they will be paid. You can receive a list of participating doctors from your insurance company. Choose a doctor from that list to minimize the fees you will have to pay.

Expiration of Benefits

Vision insurance benefits are typically limited to one time per year, or even every other year. Eye exams, for example, may be done one time per year. The insurance may base that on a calendar year. This would allow you to see the doctor in November of one year and then again in May of the following year. Other companies require twelve full months between visits. Under this program, if you saw the doctor on November 5, then you could not see her again until November 6th or later of the following year. Frames and lenses may be covered once a year, or once every other year. Before getting your heart set on new frames, it’s important to understand how often your insurance company will pay for them.

When choosing your level of insurance coverage, it is important to understand how the vision insurance works and what it will cover. Understanding your vision insurance will help you prepare for visits to the optometrist during the year. Knowing what is covered will also help you make informed decisions regarding your eye care and your choice of eyewear.

Guest author Sara Roberts writes for Just Eyewear, an online retailer of prescription eyeglasses and sunglasses.

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