How does vision insurance work?

When you have vision insurance, you send the vision insurer a check for your premium for individual plans or have the premium deducted from your paycheck for employer-sponsored plans.

In exchange, you'll receive benefits such as discounted vision exams, glasses, and contacts. Some vision care plans require you to see a provider in the plan's network. Other vision care plans simply require you to be treated by an optometrist or an ophthalmologist.

In other words, you must visit a vision care professional who has graduated from an accredited college of optometry and is licensed by the state or who has gone to medical school and is certified by the American Board of Ophthalmology.

If you already have an eye doctor you want to keep seeing, make sure their services will be covered by the plan you're thinking about purchasing. Whether you purchase your own insurance or get it through an employer, basic vision care plans range from $5 to $35 a month in premiums for an individual. To add coverage for a spouse, domestic partner, or child, you may pay slightly less per person than the plan's individual rate.

If your employer offers vision insurance, you may only have one opportunity per year to sign up during the annual open enrollment period. Be aware that some individual plans charge a one-time enrollment fee in addition to a monthly premium.

Regardless of whether you obtain your coverage individually or through work, compare the policy's total annual cost to your anticipated annual vision care expenses. You don't want to pay out more than you expect to receive.

Generally, the only eye care covered by regular health insurance is due to illness, injury, or other major medical problem that involves the eyes. Health insurance does not cover eye exams, glasses, or related expenses. Without vision insurance, you are responsible for paying the full price for eye exams and any initial or replacement eyeglass lenses, frames, or contacts.

Generally, insurance companies offer two types of vision insurance: benefits packages that give you access to a capped dollar amount of services and products and discount plans simply give you a predetermined discount, such as 20% on qualified services.

The amount of savings generated by your vision plan will depend on how many new products and services you purchase in a year. For example, according to Vision Service Plan, the national average cost for the following products and services are as follows: $206 for an eye exam, $114 for a single lens, and $242 for frames, amounting to $562.

If you purchase a basic discount plan that costs $5 per month and that provides a 30% discount on all services and products, you would save about $108. Of course, plans and expenses vary, however, expect to save between $100 and $200.

Each plan covers a different set of expenses. Before signing up for any plan, check to see if it covers everything you expect to need. Bare-bones plans usually cover only eye exams, contacts, and glasses and may function more like discount plans than they do insurance.

The amount of eye-related expenses a vision insurance plan will cover differs significantly from plan to plan. One plan might charge you a $10 co-payment for an eye exam and cover the difference. Another plan might pay for $35 of your exam and expect you to pay the rest.

Also, if a plan does offer coverage for eye surgery or permanent vision loss, it may not be anything like the coverage you're used to getting from health insurance.

The largest vision insurance provider in the United States is VSP Vision Care. Founded in 1955 by a group of optometrists, VSP currently has 88 million members and more than 40,000 doctors in its network.

VSP Vision offers two types of plans: Standard and EasyOptions. For the Standard plan, depending on your ZIP code, monthly premiums start at just $13 with an eye exam copay of $15, covering up to $150 in new frames. Though it does not cover Lasik, you can receive a coupon for an average of 15% off of your services.

The EasyOptions plan is a bit more expensive at around $24 per month. This plan has all the same benefits the Standard does but allows members to customize their benefits package by allocating more money toward the products they use more often.

Vision insurance typically includes coverage for;

Providers may offer higher-tier plans that also include appointments for lens protection and LASIK surgery. Plans may cover certain brands and often have price limits or maximum amounts set for frames and contacts (the rest would be out of pocket).

We've already touched on some of the limitations of vision insurance. Here are some additional factors to consider when deciding whether to purchase coverage:

Whether or not it makes sense to purchase vision insurance will be different for each person and their situation. Consider how often you see an eye doctor and whether or not your prescriptions change frequently to help you decide if vision insurance is worth it for you.

The average eye exam without insurance can cost upward of $150, with the average pair of glasses with lenses in the $200 to $300 range.

Assume your average annual costs are one exam at $150 and a mid-range pair of glasses costing $250; your total annual out-of-pocket cost would be $400. If you paid $15 a month for 12 months for coverage, with an annual vision checkup and pair of glasses covered, you would save $220.

If your vision is fine and you just want a check-up every few years, vision insurance may not be worth it for you.

If vision insurance sounds too complicated, you don't think you really need it, or you're not sure if it will pay off, it's fine to skip it. Unlike skipping health insurance, skipping vision insurance isn't likely to land you in bankruptcy court or put your life in jeopardy.

There are a number of ways to get discounted vision care without purchasing vision insurance. Big-box retailers like Costco and Walmart have optical centers in some of their stores. The centers offer exams by licensed optometrists and sell reasonably priced glasses and contacts. Exam costs vary by location because the optometrists who staff them are independent of the retailers. Walmart lets you look at frames and their prices on its website.

If you're not terribly particular about your frames, you can order a complete set of glasses through an online retailer at a stunningly cheap price. For example, how does $6.95 for both lenses and frames with $5.95 shipping sound? Some online stores will let you send them a pair of frames and they will add the prescription lenses. Discounted contact lenses are also available online. You will still need a prescription from an eye doctor when using these online services.

Vision insurance is more simple than a regular health insurance plan and helps you cover the cost of vision expenses for you and your family.

Vision plans typically cover:

Keep reading for a simple overview of how vision insurance works and answers to common questions people have when deciding if a vision plan is worth it.

Let’s start with the basics and break down what the typical expenses look like when you have vision insurance.

Vision insurance gives you defined costs for your vision care. Most plans will give you a flat copay for an exam, typically about $10. You’ll also have an allowance to spend on frames and a flat copay for lenses. The lens copay amount will vary depending on the type of lens you need (bifocal, trifocal, coatings, etc.). Most vision plans allow you to use the frame allowance on either frames or contacts lenses.

Vision plans usually cover:

These costs are covered for in-network providers. Similar to medical insurance, you can check for in-network vision providers using the carrier provider search.

Vision plans typically give an allowance toward new frames or contacts annually or every other year. So if you go to an in-network vision provider, you may have $100-$130 to spend on a new set of frames, or if you prefer to wear contacts, you would have that same $130 to put toward your annual spend on contacts. For exact amounts available, refer to your plan document or plan summary.

Some plans may also include discounts on laser vision correction, also known as Lasik. Typically plans include around a 15% discount for in-network Lasik providers. Lasik is often only covered in-network, so be sure to check that your Lasik provider is in-network using your carrier’s provider search.

For out-of-network providers, some vision plans offer reimbursement for eye exams performed at an out-of-network provider or glasses purchased out of network.

This means if you visit an out-of-network provider for your annual vision exam, you will pay that provider at the time of service, and then you would submit the claim for reimbursement to your vision carrier. Some plans will reimburse up to $45 for an eye exam, but the actual reimbursement will vary by plan.

You can check if your plan offers any out-of-network reimbursements by referring to your plan document or looking in the member portal.

Many people prefer to purchase glasses from out-of-network providers. Before doing so, it’s best to look at your plan summary to see how much your carrier is willing to reimburse you for eyewear purchases made at an out-of-network location. This can help you know what to expect when you submit an out-of-network claim.

If your employer offers vision coverage, you will have the opportunity to enroll once you’re hired (though you may need to wait a couple of months until the probationary period is over). There will be an open enrollment period every year, which allows you to make any changes needed to your plan, such as adding a dependent.

If you don’t enroll as a new hire, you will have to wait until the next open enrollment period to enroll.

If your employer doesn’t offer vision coverage, you can find individual plans from providers and enroll anytime.

Vision insurance policies are usually a one-year contract and require a qualifying life event to terminate. This would mean if you found vision coverage elsewhere, they would allow you to terminate the policy. Note that they will often require proof of other coverage before they will allow the termination.

One example of a qualifying life event would be if you currently have vision coverage through your employer, and you got married and decided to move your vision coverage to your spouse’s employer. You would need to let your current employer know you are moving coverage to your spouse’s policy and then submit a copy of your new ID card for them to process the termination with your carrier.

Yes, this will work similarly to health insurance. If you are the primary subscriber on a vision plan, that plan will pay first, meaning you will first submit any claims to your primary vision insurance carrier. If you are then listed as dependent on your spouse’s plan, that plan will pay second.

Since the Affordable Care Act was put in place, major medical plans offer pediatric vision coverage. This means children under 18 can get an annual eye exam and any necessary glasses covered under your medical plan. See your Summary of Benefits to determine if copays or the deductible apply.

Adult vision is typically not covered under a medical plan. That’s why adding a low-cost vision plan can help you cover the costs for your annual eye exam and new glasses or contacts every year.

Your medical plan does, however, cover general eye health. Ophthalmologists are medical doctors who help treat eye diseases or injuries such as glaucoma or a torn retina. These types of claims would fall under medical insurance, whereas a vision exam and glasses would fall under vision insurance.

Please review our Privacy Policy to understand VSP's practices regarding Protected Health Information

The name Vision Service Plan and the registered logo(s), service mark(s), and trademark(s) owned by Vision Service Plan or any of its subsidiaries or affiliates, and the contents of this site may not be used in any advertising or publicity, or other use without the prior explicit written permission of Vision Service Plan (VSP). Visionworks is an affiliate of Vision Service Plan.

VSP makes no representations about the suitability of this information for any purpose. It is provided "AS IS" without express or implied warranty, including, but not limited to, the implied warranties of merchantability, or fitness for a particular purpose. In no event shall VSP be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in action in contract, negligence or other tort action, arising out of or in connection with the use or performance of this information.

VSP has taken reasonable steps to ensure that the information on this site is accurate and timely. VSP, however, assumes no responsibility for any errors or omissions on this site or for the accuracy, truthfulness, or content of other documents that are referenced or linked to this site. Nor does VSP make any commitment to update the information contained herein. This publication and other documents are subject to change without notice. Health information content appearing is not intended as, and shall not be received or construed as patient-specific advice or a substitute for patient-specific advice.

Links to documents outside of this publication are provided as a convenience and do not necessarily reflect the views or opinions of the staff or management of VSP. Links to such documents do not in any way suggest VSP's endorsement of any product or service specified therein. Links to documents outside of this publication may be found to contain offensive material or may further link to pages that may contain offensive material.

VSP's Eye Care Information provides basic eye care information to encourage overall eye health and wellness education. Members are encouraged to review benefit information on vsp.com.

This site contains links to Third-Party (or Contractor) websites. VSP does not control or maintain Third-Party or Contractor sites. VSP does not endorse and is not responsible for the privacy practices of Third-Party or Contractor sites. Visitors should review the privacy policy of these sites to understand how they collect and use the information on their sites.

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Some features, such as VSP's Network Doctor Directory and the member's benefit information, relate directly to a member's personal information.

Email subscription information that VSP collects may be used to personalize and target content of the emails you receive from VSP, enabling us to improve our service to you. As a subscriber, you may receive information from VSP, including VSP promotions, plan, benefit or educational information and/or surveys. We will not sell or use the information outside of VSP’s family of companies. We may provide general reports on email subscription usage but we will not share email addresses or any personal information that allows for identification of individuals except as described herein.

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This website is owned by Vision Service Plan (VSP). Additional information regarding VSP may be requested by writing to VSP, Attn: Legal Division, 3333 Quality Drive, Rancho Cordova, CA, 95670.

Please review our Privacy Policy to understand VSP's practices regarding Protected Health Information

The name Vision Service Plan and the registered logo(s), service mark(s), and trademark(s) owned by Vision Service Plan or any of its subsidiaries or affiliates, and the contents of this site may not be used in any advertising or publicity, or other use without the prior explicit written permission of Vision Service Plan (VSP). Visionworks is an affiliate of Vision Service Plan.

VSP makes no representations about the suitability of this information for any purpose. It is provided "AS IS" without express or implied warranty, including, but not limited to, the implied warranties of merchantability, or fitness for a particular purpose. In no event shall VSP be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in action in contract, negligence or other tort action, arising out of or in connection with the use or performance of this information.

VSP has taken reasonable steps to ensure that the information on this site is accurate and timely. VSP, however, assumes no responsibility for any errors or omissions on this site or for the accuracy, truthfulness, or content of other documents that are referenced or linked to this site. Nor does VSP make any commitment to update the information contained herein. This publication and other documents are subject to change without notice. Health information content appearing is not intended as, and shall not be received or construed as patient-specific advice or a substitute for patient-specific advice.

Links to documents outside of this publication are provided as a convenience and do not necessarily reflect the views or opinions of the staff or management of VSP. Links to such documents do not in any way suggest VSP's endorsement of any product or service specified therein. Links to documents outside of this publication may be found to contain offensive material or may further link to pages that may contain offensive material.

VSP's Eye Care Information provides basic eye care information to encourage overall eye health and wellness education. Members are encouraged to review benefit information on vsp.com.

This site contains links to Third-Party (or Contractor) websites. VSP does not control or maintain Third-Party or Contractor sites. VSP does not endorse and is not responsible for the privacy practices of Third-Party or Contractor sites. Visitors should review the privacy policy of these sites to understand how they collect and use the information on their sites.

VSP members who enter personal information should know all communication between their computer and VSP's Web servers are encrypted using Transport Layer Security (TLS 1.2) technology. VSP's security software is the industry standard and among the best software available today for secure transactions.

Some features, such as VSP's Network Doctor Directory and the member's benefit information, relate directly to a member's personal information.

Email subscription information that VSP collects may be used to personalize and target content of the emails you receive from VSP, enabling us to improve our service to you. As a subscriber, you may receive information from VSP, including VSP promotions, plan, benefit or educational information and/or surveys. We will not sell or use the information outside of VSP’s family of companies. We may provide general reports on email subscription usage but we will not share email addresses or any personal information that allows for identification of individuals except as described herein.

By submitting your phone number, and checking the box on the enrollment form, you are agreeing to receive autodialed calls, prerecorded messages and/or text messages from VSP®, its affiliates, and third parties acting on VSP’s behalf. Text and data charges may apply. Please check with your carrier. You can cancel mobile text messages any time by replying STOP to any message.

Personal information collected and how it is used: VSP collects anonymous, non-personal information about users of this site through temporary session cookies. Cookies are small, alphanumeric identifiers that are transferred to a computer's hard drive through the user's Web browser, which enables VSP's systems to recognize the browser and provide personalized features. Session cookies expire when you close your browser.

VSP will collect data about the user's activities that do not personally or directly identify the user when visiting our website. This information may include the content the user views, the date and time that the user views this content, the products the user purchases, or the user's location information associated with the user's IP address. We do not collect personal identifying information about a user, will not link to any protected health information, and will not target ads to a user based on sensitive health data.

In addition, VSP uses technologies such as cookies and pixels to keep track of your activities on our website and the websites of our third-party advertising companies ("our Advertising Partners"), and may use those cookies to serve you more relevant advertisements. We and our Advertising Partners' sites use session cookies and persistent cookies to make it easier for you to navigate and enhance the experience of our site, and to monitor and evaluate our website's operation and use.

Any data used to serve targeted advertisements is de–identified and is not used to personally or directly identify a user. We require third-parties, including Publishers, to provide notice and obtain appropriate consent, where required by applicable law.

How it is transferred to third-party companies: VSP may work with Advertising Partners to help us recognize you and serve relevant advertisements to you when you visit a website or online service in their network. We may also work with Advertising Partners who help us recognize you across different devices in order to show you relevant advertisements. Our Advertising Partners may collect information about your activities on our website, our Advertisers' websites, and other websites or online services in their networks. We may also work with third-party companies to assist us with website analytics such as evaluating the use and operation of our website so that we can continue to enhance the website and our services.

How we use cookies and instructions on opting out of future campaigns: We may use persistent cookies to keep track of your activities when you visit our website, and to serve you relevant advertisements. Our Advertising Partners may also place persistent cookies on your device when you visit our website or our Advertisers' websites in order to help us recognize you and serve relevant advertisements to you when you visit their website or online service or websites in their networks. VSP only collects information that does not personally or directly identify you via these cookies.

Most browsers can be set to reject all cookies. The Help portion of the toolbar on most browsers will tell a user how to prevent the browser from accepting new cookies, provide notification if new cookies are received, or disable cookies altogether.

Instructions on changing personal information (for users): You may have the right to request access to and receive information about the personal information we maintain about you, update and correct inaccuracies in your personal information and have the information blocked or deleted, as appropriate. The right to access personal information may be limited in some circumstances by local law requirements. You also have the right to opt out, free of charge, from the processing of your personal information for marketing purposes. All requests for access, rectification, blocking and opting-out must be made in writing, signed, dated and mailed to VSP, Attn: Member Services, 3333 Quality Drive, Rancho Cordova, CA, 95670.

VSP's website does not direct content to Minors and do not intend to collect personal information from Minors and therefore are not subject to the Children's Online Privacy Protection Act. If the User allow his/her minor child, or a child for whom User is a legal guardian (a "Minor"), to access and use the features, User agree that he/she will be solely responsible for: (a) the online conduct of such Minor; (b) monitoring such Minor's access to and use of the Service; and (c) the consequences of any use.

VSP responds to emails, electronic messages, and other communications as soon as reasonably practical. VSP's response time shall not exceed any maximum time period that may be specified by law.

You agree that you will not use or attempt to use any feature within the Site for any commercial purpose. You agree that you will not use any robot, spider or other automatic device, process or means to access the Site. Nor shall you use any manual process to monitor or copy our web pages or the content contained thereon or for any other unauthorized purpose without our prior express written permission. You agree that you will not use any device, software or routine that interferes with the proper working of the Site nor shall you attempt to interfere with the proper working of the Site. You agree that you will not take any action that imposes an unreasonable or disproportionately large load on our infrastructure. You agree that you will not copy, reproduce, alter, modify, create derivative works, or publicly display any content (except for your own personal, non-commercial use) from the Site without the prior express permission of VSP.

Any illegal or unauthorized use of the Site shall constitute a violation of these Terms of Use. You do not have permission to access the Site in any way that violates these Terms of Use. Illegal or unauthorized use of the Site includes, but is not limited to, unauthorized framing of or linking to the Site, or unauthorized use of any robot, spider or other automated process on the Site. It shall also be a violation of these Terms of Use: (a) for any individual (or group of individuals acting in concert) to request, more than 100 pages of content from Site in any twenty-four hour period (hereafter referred to as "Abusive Use").

Violation(s) of these Terms of Use, including Unauthorized Entry or Unauthorized Use of the Site, may be investigated and appropriate legal action may be taken, including, without limitation, civil, criminal and/or injunctive redress. You understand and agree that in VSP's sole discretion, and without prior notice, VSP may terminate your access to the Site, remove any unauthorized User Content or exercise any other legal or equitable remedy available, if VSP believes that your conduct or the conduct of any person with whom VSP believes you act in concert, or the User Content you provide, violates or is inconsistent with these Terms or the law, or violates the rights of VSP or another user of the Site. You agree that monetary damages may not provide a sufficient remedy to VSP for violations of these Terms and you consent to the application of injunctive or other equitable relief for such violations.

You agree that Abusive Use of the Site, as defined above, causes damage and harm to VSP in the form of, among other things, impaired goodwill and increased expenses associated with responding to Abusive Use of the Site. You further agree that monetary damages for Abusive Use of the Site are difficult to ascertain and that proof of monetary damages for Abusive Use would be costly and inconvenient to calculate. Accordingly, you agree that injunctive or other equitable relief is warranted for Abusive Use. Therefore, you agree that if you, or others act in concert with you, alone or collectively request more than 100 pages of content from the Site in any twenty-four hour period, you, and those acting in concert with you, may be held jointly and severally liable for reasonable attorney's fees, expert witness fees and costs associated with injunctive or other equitable relief.

Driving to work, reading a news article and watching television are likely activities you perform every day. Your ability to do all of these, however, depends on on your vision and eye health. Routine eye exams will help maintain your vision as well was detect various eye problems and concerns about your overall health. Obtaining vision insurance is a way to make sure you can continue enjoying good health as well as the sights around you.

Vision coverage is similar to regular medical insurance and is one of the voluntary benefit options commonly offered through employers. When you have vision insurance, you pay a premium and the insurance company will cover part or all of the cost for vision care. Vision coverage is available in two basic types of plans:

According to Gallup, approximately 70 percent of adult Americans report wearing some type of corrective lenses. A visit with your eye doctor can determine whether you need corrective lenses and, if so, the correct prescription. Other eye concerns that will be addressed in an eye exam include checking for conditions or diseases such as glaucoma and cataracts, which can lead to vision loss.

Regular eye exams also identify overall health concerns, such as diabetes, high cholesterol and risk of heart disease or stroke before you are even aware of any symptoms. You can then follow up with a medical doctor, minimizing the effects of these conditions on your health and finances.

Vision insurance generally provides coverage for basic care and eyewear. Most vision plans will cover the following services:

Some plans may also cover other services, including laser vision care programs or even prescription protective eyewear that is compliant with ANSI and OSHA safety guidelines.

Vision plans typically do not cover replacements for frames, eyeglass lenses or contact lenses, medical or surgical treatment, vision training or experimental vision services or treatments.

For vision coverage, you pay a premium or membership fee. Then, when you visit your eye doctor or purchase corrective lenses, you pay a reduced amount for services. Eye exams will typically be covered at 100 percent or have a small copay. Corrective lenses are usually covered with a copay or a maximum allotted amount per year. If you are given an allotted amount, you would only have to pay if the eyewear exceeds that amount. For example, if your insurance covers eyeglass frames up to $120 and the frames cost $160, you would only have to pay the additional $40. Other services, such as eye surgery or treatment for eye diseases, are usually covered at a reduced rate.

Most plans will place limits on their coverage for eyewear. For example, a plan might cover a new set of eyeglass lenses once a year, eyeglass frames once every two years and contact lenses once a year. Many plans will further limit coverage to either eyeglasses or contact lenses during a plan year. Plans vary, so make sure you read your benefit information clearly.

The Affordable Care Act (ACA) does affect some vision benefit plans. If your vision coverage falls under the new ACA rules, then the vision plan will have to cover adult children up to age 26. and lifetime and annual limits on coverage will be eliminated. If the vision plan is of limited scope, then it is considered an excepted benefit and does not have to follow the new rules. Limited-scope plans include vision benefits provided under a policy separate from regular medical benefits, or vision benefits that are not an "integral part" of the group health plan.

In addition, under the ACA, pediatric vision care is considered an essential health benefit. This means that vision coverage must be available for children under the age of 19. The ACA does not consider vision care an essential health benefit for adults, so vision care is not mandatory for individuals 19 years and older. Unlike medical insurance, there will be no penalty for not purchasing vision insurance. For further information on the ACA and vision insurance, visit www.dol.gov/ebsa/faqs/faq-aca2.html.

TrueNorth offers businesses of every size comprehensive solutions to meet their business needs and those of their employees.  If you are in need of business solutions or are looking to start a business of your own, please call TrueNorth.  Our Employee Benefits division would be happy to assist you in providing the well-being of both you and your staff.  Call us today at 1-800-798-4080.