Managed Care Vision Plans

A Guide to Understanding Managed Vision Care Plans

 

What is Managed Vision Care Plans?

It is a system of providing you and your family members (the beneficiaries) with a prefunded health care benefit that is designed to meet your eye care needs. Also known as, “vision insurance,” it is commonly used to describe health and wellness plans designed to reduce your costs for routine preventive eye care (eye exams) and prescription eyewear (glasses and contact lenses).

 

Where Can You Get Vision Insurance?

Vision insurance often is a value-added benefit linked to indemnity health insurance, health maintenance organizations (HMOs), and preferred provider organizations (PPOs) that have contracted with managed vision care networks to provide eye care services

Indemnity Health Insurance: a traditional health insurance that allows policyholders access to medical providers of their choice.

Health Maintenance Organizations: a group of healthcare providers – doctors, laboratories, hospitals, and the like – employed to provide health care to plan members at discounted rates. Usually, plan members are required to access health care (including vision care), only from HMO providers.

Preferred Provider Organizations: a network of healthcare providers organized to provide healthcare services to health plan members at a fixed rate below retail prices. Plan members may opt to access out-of-network providers, but usually at a greater cost.

 

Benefits to Having Vision Insurance:

  • Access to network of providers, including optometrists and ophthalmologists, eyewear stores, optical laboratories, and LASIK surgeons
  • Routine, preventive eye care services at reduced rates

 

What Kinds of Vision Insurance Plans Are Available?

Vision insurance typically comes in the form of either a vision benefits package or a discount vision plan. Both kinds of vision insurance can be custom-designed to meet the requirements of a wide range of customers.

A vision benefits package provides free eye care services and eyewear within fixed dollar amounts in exchange for an annual premium or membership fee and a relatively small co-pay (fixed dollar amount) each time you access a service. A discount vision plan provides eye care and eyewear at discounted rates after you pay an annual premium or membership fee. Both may also include a deductible – a fixed dollar amount you must pay your eye care provider out-of-pocket before the insurance benefits take effect.

Vision plans generally cover or provide discounts on: annual eye examinations, eyeglass frames, eyeglass lenses (including coatings and enhancements), contact lenses, and discounted rates for LASIK and PRK.

 

What Does Vision Insurance Cost?

Varies on program and your state of residence.

VSP Rates.png

EyeMed Rates.png

 

What Benefits/Drawbacks Do Each Offer?

VSP:

  • Offers individual and family eye care benefits if you company doesn’t
  • You will have to pay a copay when visiting a doctor
  • Have to pay out of pocket for: lens enhancements
  • Offers discounts on LASIK and PRK surgery

 

EyeMed:

  • Provide ID cards with enrollment for individuals and family plans.
  • No waiting period; can be used the day of enrollment
  • In-network providers do not need to fill out claims; out-of-network providers do however
  • Out-of-network benefit coverage is provided, but members must pay for services first
  • Coverage will end on any premium due date the Company elects to non-renew the policy or on any date you provide a written request to cancel coverage

 

Davis Vision:

  • Free one-year breakage warranty on any exclusive collection or in-network retail frame produced in one of their laboratories
  • Select one of their frames, often pay nothing out-of-pocket for it
  • Partnered with EPIC Hearing Healthcare to offer discounts on hearing aids
  • Partnered with Visionworks to raise awareness for the need for school-aged children to receive annual eye exams
  • Diabetic outreach program designed to increase diabetic retinal exam compliance rates
  • Offer Fit Fwd plans to companies; tools and resources to foster health and wellness among employees or enhance existing wellness programs**

 

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** We are not health insurance consultants – please refer to your health insurance guidelines with any questions.

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