Vision Insurance
Vision insurance helps pay for routine eye care, prescription eyewear, and in some cases, eye surgery. Like dental insurance, vision plans typically feature lower premiums and emphasize preventive care.
Types of Vision Plans
Vision PPO
| Feature | Description |
|---|---|
| Network | Discounted rates at participating providers |
| Out-of-Network | Partial reimbursement available |
| Flexibility | Can see any eye care provider |
| Cost | Moderate premiums |
Vision HMO
| Feature | Description |
|---|---|
| Network | Must use in-network providers only |
| Out-of-Network | No coverage except emergencies |
| Cost | Lower premiums than PPO |
Discount Vision Plans
- NOT insurance – no claims
- Discounted rates at participating providers
- Low membership fees
- No waiting periods
- Members pay directly at discounted rates
Covered Services
Vision plans typically cover:
Eye Examinations
| Service | Typical Coverage | Frequency |
|---|---|---|
| Routine Eye Exam | Covered with small copay ($10-$25) | Once per 12 months |
| Contact Lens Fitting | Covered or discounted | Once per 12 months |
| Dilation | Included with exam | As needed |
Materials (Eyewear)
| Item | Typical Coverage | Frequency |
|---|---|---|
| Frames | Allowance ($100-$200) | Once per 12-24 months |
| Standard Lenses | Covered in full | Once per 12 months |
| Contact Lenses | Allowance (in lieu of glasses) | Once per 12 months |
| Lens Enhancements | Extra cost or partially covered | — |
Lens Enhancements and Upgrades
Common upgrades with additional costs or discounts:
- Progressive (no-line bifocals) lenses
- Photochromic (transition) lenses
- Anti-reflective coating
- Scratch-resistant coating
- Polycarbonate lenses (impact-resistant)
- High-index (thin) lenses
Key Vision Insurance Terms
Frame Allowance
The frame allowance is the maximum amount the plan pays toward eyeglass frames:
- Typical range: $100 - $200
- If frames cost more, member pays the difference
- Some plans offer 20-40% discount on amount over allowance
Materials Copay
A materials copay is a flat fee for lenses and/or frames:
- Typically $10 - $50 per pair
- May be separate copays for frames and lenses
Frequency Limitations
Frequency limits determine how often benefits can be used:
| Benefit | Typical Frequency |
|---|---|
| Eye exam | Every 12 months |
| Lenses | Every 12 months |
| Frames | Every 24 months |
| Contacts (in lieu of glasses) | Every 12 months |
Important: Members typically choose either glasses OR contacts per benefit period—not both.
Vision Insurance vs. Medical Insurance
| Condition | Covered By |
|---|---|
| Routine eye exams | Vision insurance |
| Prescription glasses/contacts | Vision insurance |
| Glaucoma screening | May be vision or medical |
| Eye injury or disease | Medical insurance |
| Cataracts, macular degeneration | Medical insurance |
| Diabetic eye exam | Medical insurance |
| LASIK surgery | Usually not covered; may have discount |
Exam Tip: Medical conditions of the eye (disease, injury) are covered by medical insurance, not vision insurance. Vision plans cover routine care and corrective eyewear.
How often can a vision plan member typically get new eyeglass frames?
Which of the following would be covered by medical insurance rather than vision insurance?
What is a "frame allowance" in vision insurance?
26.3 Accidental Death and Dismemberment (AD&D)
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