As we finally leave winter and the flurry of open enrollment activity behind, it’s time to get into the full swing of the year. We’ve put our heads together and come up with the top 3 things you should know to make your vision plan blossom (see what we did there?).
1. Let the eye exam shine
About 75% of people in the United States have some form of vision correction,1 yet ask them what stereopsis is and they may think it’s the sound system at an IMAX movie.
Stereopsis is actually depth perception, and it is among the many eye functions tested during a complete eye exam. For those who have never been to the eye doctor, it can sound like scary stuff. But it’s really about as scary as a kids’ movie – if you know a little about what to expect at the eye doctor’s office.
Check out our Top 10 things to expect at an eye exam for insights you can share with employees. And remember, with all the time your employees and their families spend in front of digital devices, annual comprehensive eye exams can help keep them healthy, happy and productive.
2. Clarity on the benefits
In today’s digital culture, concentration and attention are at a premium,1 which means we may only give seconds, if any, to the fine print. And when it comes to understanding your vision benefits, you may not be seeing all that’s offered.
At EyeMed, we know from our own research that many people, including our members, have much to learn about their vision benefits. In fact, many of those with vision insurance don’t understand terminology like co-pay and allowance—only 14 % of Americans understand many common insurance terms, according to a study in the Journal of Health Economics.2
To help bridge that gap of understanding, we’ve created a quick guide to help you and your employees get the basics of a vision benefit.
How do I get vision benefits? You may be eligible for vision benefits through your employer, which means you tend to pay lower prices since the employer is negotiating for a group of people. Others, however, opt to purchase plans independent from an employer for one or all members of the family.
What’s a co-pay?
A co-pay is the fixed amount of money you owe the doctor at the time of your visit. Co-pays vary based on the plan your employer has selected.
What’s an allowance?
An allowance is a set amount of money the plan covers toward the purchase of eyeglass frames or other items. Here’s a simple-to-follow example. If your plan includes a frame allowance for $100 and you select frames that cost $130, you’ll owe $30 for frames at the time of purchase. As an EyeMed member, you may also receive an additional 20% off the remaining balance at participating providers – so your final cost for the frame could be as low as $24.
What are the different “materials”?
Vision materials refer to frames, lenses or contact lenses offered at a provider location. Materials may come with certain limitations and exclusions regulated by your policy or by the materials manufacturer.
A standard plan may have frequency limits as detailed below:
Lenses – provided once in each benefit period and in lieu of contact lenses. Frames – provided once in each benefit period Contact Lenses – provided once in each benefit period and in lieu of the coverage to lenses in a frame.
What’s a complete pair?
A complete pair refers to the purchase of both a frame and prescription lenses. Some discounts may apply only to the purchase of a complete pair of glasses.
How much will I pay out-of-pocket?
What you pay depends on your specific benefits and what materials you choose. Understanding your co-pays and allowances as described above is the first place to start, but make sure to check out your full benefit summary or log on to your vision benefits account to see your full list of benefits. As an example, EyeMed members save an average of 72% with their benefits compared to those without vision coverage.4
My friend at another company has the same vision carrier, but we don’t pay the same for exams or eyewear. Why not? Each employer selects a vision plan for their workforce based on what they decide their employees need as well as how much the company and the average employee can afford.
When can I start using my benefits?
Usually, vision benefits last for 12 months and start either when you purchase your benefits directly or when the new benefit year starts through your employer. Check your benefit details so you’re sure when your plan coverage starts and ends.
How can I use my benefits?
Simple. The first step is to connect with an eye doctor near you and make an appointment. You’ll also want to pull up the details of your benefits before going so you know what to expect heading in.
3. Leap year, calendar year and date of service – understanding benefit frequency
Like the four year wait for leap year, many of our vision programs provide a rate guarantee for four years. Luckily the rest of the benefits occur on a calendar year or date of service.
- If your plan frequency reads “Once every Calendar year” on your benefit summary then benefits will refresh every year as of January 1st.
- If your plan frequency reads “Once every Other Calendar year” on your benefit summary then benefits will refresh every other year as of January 1st.
Date of Service
- If your plan frequency reads “Once every 12 months” on your benefit summary then benefits will refresh 12 months after the last date of service.
– For example, if a member used their benefit on March 17, 2017 then benefits will refresh on that day the following year, March 17, 2018.
- If your plan frequency reads “Once every 24 months” on your benefit summary then benefits will refresh 24 months after the last date of service.
– For example, if a member used their benefit on March 17, 2017 then benefits will refresh on that day the following year, March 17, 2019.
1. “Get a Grip on your Information Overload with Infomagical,” http://www.npr.org/sections/alltechconsidered/2016/01/25/463232382/get-a-grip-on-your-information-overload-with-infomagical
2. Americans Don’t Understand Insurance, Let Alone Obamacare,” by Bruce Japsen Forbes, Aug. 10, 2013, http://www.forbes.com/sites/brucejapsen/2013/08/10/americans-dont-understand-insurance-let-alone-obamacare-study-shows/
3. “Buying glasses? When considering extras, keep your eyes open,” by Mary Jacobs, Dallas Morning News, May 6, 2013, http://www.dallasnews.com/lifestyles/health-and-fitness/health/20130506-buying-glasses-when-considering-extras-keep-your-eyes-open.ece
4. Based on weighted average of sample transactions; EyeMed Insight network/$10 exam co-pay/$10 materials co-pay/$120 frame or contact lens allowance.