Vision Benefits Explained: How to Break Down the Details of Your Plan

Today’s post is a little more serious than I usually am. I doubt I’ve ever really mentioned it before, but I’ve had bad eyesight my whole life and have worn glasses since I was in elementary school. I switched to contacts in middle school, and I’ve had my share of problems with my eyes getting worse, needing more expensive glasses, etc. Growing up my parents always took care of our medical bills, but now that I’m an adult I have to say I am extremely happy I have a job that offers a good benefit plan. With the help of my eye health insurance, I am able to afford my contacts and glasses each year. I also know how frustrating and confusing health insurance benefit details are! To make it a little easier for you to figure out the details of your specific plan, read the following post.

Understanding Vision Insurance

For a lot of people, making sense of vision insurance benefits isn’t always an easy task. But, it’s
important to take a close look at your plan to ensure you get the most out of it. While all plans are
different, there are some commonalities between them. Take a look at this rundown of some of the
most important things you should know about your vision benefits.

Common types of vision plans

If your eye insurance is provided through your employer, it’s likely in the form of vision benefits package
or a discount vision plan.

*A typical vision benefits package covers eye care, exams and eyewear in exchange for an annual or monthly fee, as well as fixed copay at the time of service.

*A typical discount vision plan provides eye care, exams and eyewear at a discounted rate after an annual premium or membership fee is paid.

Sometimes vision benefits packages and discount plans will require that a deductible is paid first before
insurance benefits take effect. Usually both varieties can be somewhat customized to better meet the
needs of the patient. This often comes in the form of different insurance plan levels that range in their
level of coverage. The following basic services are what most vision plans cover:

*Annual eye exams

*Eyeglass frames and lenses

*Contact lenses

*Discounted rates for LASIK and PRK refractive surgeries

If you participate in a flexible spending account (FSA) thorough your benefits package, you can
oftentimes use those dollars to pay for the cost of eyeglass lenses and frames, contact lenses and Lasik
surgery. Timing is critical with an FSA, so be sure to find out when you need to use these funds so you
don’t lose them and can put them to good use.

Choosing a doctor

Once you identified what services you’re eligible for under your plan, you can select a doctor and start
receiving eye care. If you don’t already have an eye care professional that you see regularly, you’ll want
to choose the right one for your unique needs. Ophthalmologists, optometrists and opticians all play
important roles when it comes to eye health, but their training and expertise differ. Here’s how you can
differentiate between the three:

*Optometrist: An optometrist, has a doctor of optometry (OD) degree. They have completed four year college degree, with an emphasis in science, followed by four years of optometry school. They have a license to practice optometry, which involves performing eye exams, detecting and prescribing medicine for specific eye conditions and diseases, and prescribing corrective lenses like eyeglasses and contact lenses.

*Ophthalmologist: An ophthalmologist is a medical or osteopathic doctor who specializes in vision and eye care. They have completed medical school and have four to years of additional medical training, and are licensed to practice medicine and surgery. In addition to preforming surgery, diagnosing and treating eye diseases, most ophthalmologists prescribe and fit eyeglasses and contact lenses

*Optician: An optician is a technician who is trained to design and fit eyeglass lenses, frames and contact lenses. They take the prescription prescribed by an ophthalmologist or optometrist to tailor the corrective lenses, but do not diagnose or prescribe to patients. Certain states require opticians to be licensed.

Optometrists and ophthalmologists both perform routine eye exams and both types of eye doctors are
trained to detect, diagnose and manage eye diseases that require medical and non-medical treatment. If
you have an eye condition such as cataracts, glaucoma or macular degeneration optometrists and
ophthalmologists typically work together to ensure you receive the best care possible.

Making sure the doctor you choose is covered

Most vision insurance plans segment doctors between in-network and out-of-network providers.

*In-network: These providers have agreed to accept your insurance plans’ contracted rate as payment for their services. This includes your share of the cost (typically your co-pay or deductible) as well as your insurance company’s.

*Out-of-network: These providers have not agreed to a set rate with your insurance provider and may charge more than an in-network provider. Your plan may also charge higher co-pay for these providers, or not cover them at all, leaving you to pay the full cost for services.

To get the most out of your insurance coverage, it’s best to choose an in-network provider. Check your
insurance company’s website for a list of providers, or call your doctor’s office before your appointment
to verify your insurance is accepted by them.

Take advantage of your vision benefits

Once you have a good idea of how your vision benefits work, don’t forget to use them! Monitoring and
maintaining proper eyesight is one of the most important pieces of a person’s overall health, and
shouldn’t be neglected. Take advantage of your vision benefits on an annual basis, and ensure all the
family members covered by your plan do as well so you can ensure you all have a lifetime of healthy

Post is sponsored by LensCrafters.


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