Understanding and Utilizing
Your Vision Plan Benefits
Choosing your vision plan and
utilizing the benefits is a
little different than a small
group health insurance policy.
The insurance itself operates
more similar to the dental
coverage system, where a
member receives specified
coverage for certain expenses
and then is responsible for the
remainder of the expense. This
is different than small
group health insurance
which covers you for medically
necessary expenses after you’ve
reached your annual max out of
pocket limit.
Reading Your Benefit
Description
Benefit descriptions may look
something like this:
Exam……. $10 every 12 months
Lenses….. No charge every 12
months (single, bifocal, &
trifocal only)
Frames…..$20 ($150 limit)
Contacts….$20($150 limit)
This benefit means you can
receive an eye exam for either
glasses or contacts, not both in
the same 12 months, for the
proper fitting and qualification
of candidacy for type. Lenses
come free with the glasses
purchase so this is a pretty
strong plan, but free for only
specified types of standard fare
glasses and only once a year.
After you’ve paid your co-pay
then for either glasses or
contacts plus the co-pay for the
office visit and examination you
receive a $150 allowance towards
your frames or contact lenses
choice. Eye exams usually
include vision problems,
correction, and any visible
health conditions.
Provider Network
If you have an existing eye
doctor check to see what vision
plan they accept prior to
purchasing the small group
vision plan for your employees.
If you are new to the vision
plan and don’t have an eye
doctor the contact the agent or
vision carrier website
immediately to find a contracted
doctor in your neighborhood and
make an appointment. This way
you’ll easily find a doctor
maximize plan benefits.
Additional Savings and
Discounts
Often times the California small
group vision service plan will
have additional benefits such as
discounts for the expenses you
incur beyond your allowance for
glasses. Or, you may see
discounting on laser correction
surgery for contracted providers
and items like scratch resistant
coating.
Out of Network
Reimbursement
To get the
best value from your vision plan
you should visit your contracted
in-network doctors. If you
happen to receive services out
of network co-pays still usually
apply, you just lose contracted
rates for services and your
annual benefit allowances are
usually reduced. A 50%
reduction or greater in benefit
allowance is not atypical. You
will be required to pay your
provider at the time of service
and file out of network claims
form back to the vision plan
carrier.
The Importance of Vision
Take care of your employees
eyes. Vision accounts for the
vast majority of our sensory
input. Imagine a world without
vision. Ignoring vision health
problems can be devastating.
Diabetes, macular degeneration,
accidents, and a whole variety
of conditions are out there so
it’s important to play it safe
and make sure you receive
routine eye exams and take care
of any issues promptly. For
more information visit our
general overview section on
Vision Care Plans.
Other
important
resources:
California
Small Group
health quote
California
Small Group
online
doctor
listing
California
Group
Enrollment
and
Eligibility
Center
