Jul 11, 2011

Vision Care

Most of us would rank vision as a very important, if not the most important, of our senses. Yet vision care is often neglected. Eye disease, treatment, and surgery traditionally are covered under hospital, surgical, major medical, and comprehensive medical policies. However, most of these plans exclude routine vision examination and eyewear from coverage. Separate (freestanding) vision plans cover services such as routine examinations and materials (products) such as lenses, frames, and contact lenses. In a purist sense, some do not consider this coverage insurance because of the absence of illness or disease. Nevertheless, the need for appropriate vision care is real, as about 60 percent of the adult population in North America wears corrective eyewear. A routine vision exam not only confirms whether prescription eyewear is necessary but may detect unrelated problems such as diabetes and high blood pressure. Aside from the obvious medical benefits to employees, vision care plans have the potential of reducing accidents and increasing production, factors that are of major importance to the employer. Vision care often is compared to dental care because of its frequently elective and predictable nature. However, despite general reductions in employee benefit programs, some—not many—employers are adding or continuing to provide vision care benefits.


There are three types of vision care professionals.
Ophthalmologists are medical doctors (MDs) specializing in the total care of the eye, including diagnosis, treatment of eye diseases, and surgery. Many perform eye examinations and prescribe corrective lenses.
Some also dispense corrective eyewear. An ophthalmologist typically completes four years of premedical training, another four years of medical school, and subsequent internship/residency.
Optometrists are doctors of optometry (ODs) who are licensed to examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye, and associated structures as well as diagnose related systemic conditions. They are trained to detect eye disease and/or symptoms requiring the attention of ophthalmologists. In addition to performing vision examinations and prescribing lenses, most optometrists dispense glasses and contact lenses. An optometrist typically completes undergraduate work and is graduated from a college of optometry.
Opticians fit, adjust, and dispense eyewear (lenses, frames, and contact lenses) prescribed by ophthalmologists and optometrists. They are eyewear retailers and provide advice on which lenses and frames are most appropriate. Many grind and fabricate eyewear, verify the finished products, and repair and replace various ophthalmic devices. Optician certification, licensure, and registration vary by state, as do training and apprenticeship.

Covered Benefits

Vision Examination

A thorough examination includes a history of general health, vision complaints, and an external and internal eye exam. Other services may include various ocular tests, usually including but not limited to coordination of eye movements, tonometry, depth perception (for children), and refraction testing for distance and near vision. In addition to the possible need for corrective eyewear, the exam could detect cataracts, glaucoma, diabetes, and brain tumors. Some plans allow an examination at 12- or 24-month intervals, and it is up to the employee to arrange for eyewear if needed. HMOs often feature "exam-only" plans.


The lens is the heart of sight-corrective material. Single-vision lenses are the most widely used, with multivision lenses (bifocal, trifocal) also being dispensed in large quantities. Plastic has replaced glass as the predominant lens material, and a wide array of lenses, such as oversized, photochrometric, and tinted, are available. Most plans consider these "cosmetic extras" and outside normal plan limits. Many plans do provide benefits for contact lenses even though they are likely to be worn for cosmetic rather than for medical reasons.
Many dispensers have an in-house laboratory for grinding and fabrication of the more routinely prescribed eyewear, while others use full service labs.


The cosmetic element is much more obvious in the area of frames than in lenses. Frames are increasingly being selected for cosmetic purposes and at times are part of a fashion wardrobe. The cost can run into hundreds of dollars for plastic or metal frames of almost limitless sizes, shapes, and colors. Herein lies a dilemma for the payor. The frame is a must, but how does one avoid paying for fashion while giving a fair reimbursement for utility? Certain plans make allowances up to a specified dollar figure, while others approve a limited selection; for example, $100 frames each for men, women, and children.

Vision Benefits in Flexible Benefit Plans

Flex plans increasingly include ancillary benefits, including vision care. They enable an employee to choose among various coverages, taking into account factors such as overall health, spouse coverage, and specific family needs. Although the design of these plans varies, employers sometimes allocate a certain number of "flex credits" to each employee, who then uses these to "purchase" benefits. Each employee chooses the benefits that best fit his or her needs. Once the employer allocation has been used, the employee may purchase additional benefits at his or her own cost. They place vision care in competition with other coverages.

Flexible Spending Accounts (FSAs)

If not covered under a medical plan or a freestanding plan, eligible vision care expenses are covered by a flexible spending account if the employer maintains one. Under an FSA arrangement, the employee may reduce income and Social Security taxes by funding benefits such as vision care with pretax dollars.
At the beginning of the plan year, employees can designate a certain amount of money (up to a maximum) to be deducted from salary, thereby reducing the base upon which taxes are paid. The employer holds the money and "reimburses" the employee upon verification of covered expenses. 

Occupational Safety and Health Administration (OSHA)

OSHA requires employers to provide protective eyewear to employees in positions exposing them to the danger of eye injury. These "safety glass" programs are usually outside the normal health benefit package.


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