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Questions & Answers About Vision Insurance

How and where does one obtain vision insurance?

Individuals can buy a vision benefit plan.  Vision insurance plans may be available through your place of employment, school district or through social plans like Medicare or Medicaid.

Indemnity health insurance is traditional insurance, which allows policyholders to access medical providers of their choice. 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).

An HMO health plan requires its members to access health care only from HMO providers.  HMOs provide health care services to plan members at discounted rates. HMOs include a range of health care professionals – doctors, laboratories and hospitals.

A PPO is a network of health care professionals who provide health care services to membership at discounted rates. Plan members may use out-of-network providers, but they usually will pay more for the services rendered.

What types of vision insurance plans are available?

Vision insurance comes in two forms, a discount vision plan or a vision benefits package.

Discount Vision Plan - Eye care at fixed discounted rates after an annual premium or membership fee and a deductible are paid.

Vision Benefits Package - Usually, a vision benefits package requires an annual premium or membership fee, a yearly deductible for each enrolled member and a co-pay each time a member accesses a service.

Discount vision plans and vision benefits packages are  custom-designed to meet the different requirements of a wide range of customers, such as unions, big, mid- size and small companies and school districts.

What is included in vision insurance?

Standard Vision insurance usually includes the following services and products:

  • LASIK and PRK vision correction at discounted rates
  • Annual eye examinations
  • Contact lenses
  • Eyeglass frames
  • Eyeglass lenses

Usually, services acquired from network providers are more affordable than services from out-of-network providers.

Are there payment options?

If group vision insurance is available from your employer, you pay for it through payroll deductions or flexible spending accounts.

An flexible spending account, sometimes referred to as a cafeteria plan, allows an employee to use pre-tax dollars to purchase selected health benefits such as vision insurance. This plan saves your 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 are self -employed or if your employer does not offer vision insurance then you can expect to be billed monthly or annually.

Will my insurance cover my examination?

Yes, provided you are currently eligible for an examination. Most insurances have limits on how often you may use their benefits. You may be required to pay a copay or a deductible out of pocket.

How do I know what I am eligible for?

Your insurance card will have a telephone number and/or a website where you can get your benefit information.  In most cases we will verify your benefits for you before your visit.

Does insurance pay everything?

No. Most plans have a schedule of benefits that may require out of pocket payments for:

  • Copays- the part you pay for a covered service, insurance pays the rest
  • Overage- the amont you pay when your frame, lens, or contact lens exceeds the amount the insurance will pay
  • Non Covered items- items or services not covered under your insurance