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Understanding Vision Insurance Plans: Get the Most from Your Plan

Understanding Vision Insurance Not all insurance plans include vision coverage and even those that do may offer different benefits. Knowing what is and isn't covered by your insurance plan is critical, since it can influence how you care for your eyes. If you understand how your plan works, it'll be a lot easier for you to use it to your own advantage. It's also important to know who you can turn to when you inevitably have questions about your coverage.

Choose the right plan
The first step to good vision coverage is, of course, selecting the right plan to begin with. There are several things that you should consider when choosing an insurance plan.

  • The types of plans that are available
  • The coverage that you'll need, including both the essentials, like yearly eye exams, plus options you may be considering, such as LASIK.
  • The premium, co-pays, the co-insurance amounts
  • The deductibles

There are several types of insurance plans that are available, ranging from straightforward traditional insurance coverage to defined contribution plans including cafeteria plans, flexible spending accounts, health reimbursement arrangements and health savings accounts. For some types of plans, only serious eye procedures may be covered while others cover preventative care as well.

How much coverage you'll need will depend on your medical history, current health, your age, lifestyle and family status. A single, young and healthy person is likely to need less insurance than an older, married person with children.

There are several things that can influence the amount that you pay for your insurance coverage, including the type of deductible that you carry and the actual benefits that are included. Generally, your premium can be higher if you need a lower deductible amount, and it can be lower if you carry a high deductible. You have to crunch the numbers for your own specific situation to know which type of deductible makes the most sense for your family.

The deductible is the amount that you have to pay before the insurance will pay a claim. For instance, if your deductible amount is $500, you must pay for that much yourself before you will be reimbursed for further medical expenses. In some types of insurance plans, the amount of the deductible is set and regulated by the federal government. Choosing a plan with a higher deductible may allow you to have far lower premium but it will also mean that you will have to pay more before your insurance even kicks in. Again, you have to make sure that you are choosing the right coverage and amounts for your own needs.

Your co-pay amount is the amount that you will pay whenever you go to the doctor, your eye care professional or get other types of covered services. Your co-insurance amount is what you will pay after the deductible amount is met. (You will pay a portion and the insurance company will pay the rest.)

If you are getting insurance through your job, your employer can let you know which types of plans you are eligible for and what the restrictions are for each of them. If you are purchasing insurance on your own, you should consult a professional insurance agent and your accountant or financial planner. This is definitely one of those cases where spending a little money up front for a professional's opinion could save you a lot of money in the future.

Choose the right provider
In the world of insurance coverage, there are in-network and out-of-network providers. While your insurance plan may not require you to choose an in-network provider, you will need to pay an out-of-network provider full price up-front for any vision services you receive. You may later be reimbursed for some of these expenses by your vision insurance, but you may not. In some cases, the out-of-network provider may need to be approved by the insurance company ahead of time in order for you to qualify for reimbursement.

When you sign up for your insurance coverage, you will be given a list of the accepted providers and the services that they provide. If you already have an eye care professional, you may have to decide whether to stay with that doctor or choose a new one.

Know the terminology
If you are getting ready to sign an insurance agreement, make sure that you completely understand of all of the terms that are involved. If you are not sure what is meant by such things as HIPPA, FSA, HRA or other insurance-related terms, it is important to have them explained.

Be prepared
When you schedule an appointment with your eye doctor, you may need to provide:

  • The name of your insurance company
  • The name of your insurance plan
  • Your member ID number

In addition to the above, when you actually visit the office, you should have:

  • Proof of insurance (such as your membership card)
  • Enough money to cover your co-payment and any other fees you may incur. (Many providers will only accept payment in cash, so if this is a problem, you should find out ahead of time if you can pay with a check or other method.)
  • Your insurance company's phone number, in case you have any last minute questions.

When in doubt, ask
Never make guesses about your health coverage, or you could end up spending a lot more money than you planned or budgeted for. Or worse, you could turn down services believing you can't afford them, when they would actually have been covered by your plan.

If your insurance plan is through your employer, the human resources department may be able to provide answers. Alternatively, you can call your insurance company directly. (The number is often right on the back of your membership card. Very handy!) Your accountant can also help when it comes to questions about financially planning for your future and tax concerns associated with certain types of plans, such as a Flexible Spending Account.

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