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Understanding And Maximizing Your Vision Insurance Benefits

Use It Or Lose It – How to NOT miss out on your benefits this year.

Do you have vision benefits and Flexible Spending Account(FSA) money that needs to be utilized before December 31st?

If you have vision insurance benefits or a FSA account it is important for you to know that in most cases any unused benefits cannot be transferred over to the new year typically beginning on January 1st. This creates a last-minute frenzy in which patients are trying to make the best decision possible about how to spend their hard earned dollars. Inevitably, many of these situations take place from December 26-30, around closing time, with family in tow, dinner on the mind and patience in short supply. This combination of time and place to try and make sense of your vision plan can sometimes be daunting. Front desk staff, opticians and doctor’s assistants are trained to be read, understand and help navigate through the murky waters of your vision benefit plan details.

Vision Source - Use It. Don't Lose It.

What are some of the challenges that sometimes arise when trying to verify benefits?

  • A patient’s date of birth wasn’t entered correctly by the insurance company or employer preventing the ability to obtain an authorization.
  • A patient is not showing eligibility when benefits haven’t been used, thus preventing patients from utilizing their vision benefits.
  • Insurance companies are already closed for the holidays and authorization is not able to be obtained until the next business day or the following year (the worst!).

What complicates matters is that each vision plan has its nuances. Staff members are trained throughout the year in order to be apprised of any benefit changes. This helps ease some of the frustration of last minute eyeglass and contact lens shopping.

FAQ’s Regarding Vision Insurance Benefits

Below is a list of FAQ’s that are asked by patients regarding their benefits. There are a few tips to help you maximize your vision insurance benefits and take steps to be prepared for the end of the year rush. Remember that making your appointment ahead of time ALWAYS makes it easier for us to verify your benefits and take care of any potential issues that can arise. Now you can get back to enjoying time with the family during this holiday season.

We also provide answers to questions you didn’t even know you had! For example, did you know that some insurance plans cover non-prescription sunglasses once you’ve had Lasik surgery? Or that some insurance plans cover not just one, but multiple pairs of glasses?

1. How do my benefits work?Benefits vary depending on the insurance plan and on the rates negotiated by the company you work for. Most plans will cover the following with a co-pay (your cost is fixed regardless of the provider prices) or an allowance (they pay a certain amount towards the services and products): Comprehensive eye examframes, and standard plastic lenses. Contact lens exams and contacts are considered elective and range from being covered completely by a co-pay (like VSP) to not being covered at all. Coatings, upgrades and add-ons such as polycarbonate lenses (thin and light weight), anti-glare, transitions and tint are also considered electives and the amounts covered can vary as well. However, every year, more insurance plans are offering their members excellent prices on these upgrades and add-ons that make glasses more comfortable to wear and elevate the patient experience. Some benefit plans offer benefits on MULTIPLE pairs of glasses and/or will offer discounts on multiple pairs. Did you know: Eyemed offers 40% off a complete second pair of frames and lenses once benefits have been used.

Vision Source Benefits


2. If I use my benefits in December, can I use them again in January?Some insurance plans renew every calendar year. That means that you could use your vision benefits on December 31st and then turn right back around and use them again on Jan 1st. This is particularly helpful if you liked two different styles of glasses when you were shopping, need or want some sunglasses, or use contact lenses. Your out-of-pocket, as always will depend on what is covered by your insurance. Some insurance plans renew from the date of service. For example, if you purchased glasses on July 10, 2013, you would not be eligible for next year’s benefits until July 11, 2014.

3. If I use my benefits at the end of December, but my order won’t come in until January, will my insurance still pay the claim?Insurance claims are paid based on the date of service. So if you come in on December 31, and pay for your services and products, the claim submitted to your insurance plan will show December 31st and would be paid regardless of whether the products ordered are in stock or not.

4. Can I use two separate benefits on the same pair of glasses?This situation normally arises when a child has vision benefits through both parents, or a patient has coverage and is also covered by their spouse. Most optical stores will file one insurance benefit per one pair of glasses. You have the option of then taking the receipt, along with the Explanation of Benefits (EOB) provided by your insurance company (once the claim has been processed) and then submit that to the secondary insurance company for reimbursement.

The exception to this is if the patient and spouse are both covered by the SAME insurance plan of which a practice is a preferred provider for, such as VSP – in this case, the insurance company must be notified ahead of time to get a special approval for filing. It is not recommended to wait until the last minute to do this as insurance companies are not always open during shopping hours, (go figure) and therefore can make the filing process that much more difficult. In the case of a patient having their own plan and then being covered by a spouse, the primary benefits must be used first before submitting to the spouse’s insurance for reimbursement.
Air Optix Color Contacts
Most patients though, will use their second benefit on contacts, a back-up pair of glasses, or sunglasses depending on what their specific need is. A great optical will review pricing for the services and products you need using either plan to get you the best price.

5. I need contacts, glasses and sunglasses. Can I get all 3 with my insurance?Although most insurance plans cover either one pair of glasses or contacts, there are some that cover multiple pairs and many that give discounts for additional products purchased – this is called a ‘Multiple Pair Benefit’. Staff members at your optical can find out if your vision insurance plan offers a multiple pair benefit ahead of time.

6. Can I get non prescription sunglasses (plano) with my FSA account?FSA plans will cover Rayban Wayfarernon prescription sunglasses if your optometrist makes a note on your prescription that they are necessary. A copy of the prescription must be made and submitted along with your receipt to your FSA in order to be covered.  If you have a FSA debit card, we still recommend that you submit a copy of your prescription along with your receipt in order to avoid denials. However, each vision insurance plan is different, so calling them personally, or having one of the staff members at your optical call ahead of time is recommended.

7. Can I get a gift certificate with my FSA account?Sorry! Gift certificates do not qualify as valid purchases on FSA accounts.

8. Can I prepay for my glasses with my FSA account, using my insurance, and come back in January to pick them out?Unfortunately, no. A line item claim is submitted to your insurance with a detail breakdown of the exact services rendered and products purchased showing the date of service. In order to be able to utilize your vision benefits and be reimbursed for your FSA account, the purchase must be done before December 31st. The receipt/claim cannot be modified or made to reflect a different date if purchased after December 31st. Anything selected after January 1st will reflect the actual date of service.

9. I have an FSA, how do I combine that with my current benefits?If you have an FSA, normally your vision insurance benefits are applied first to your exam (if your prescription is expired) and products purchased, then the remaining balance is charged to your FSA account. The real savings comes in when using your multiple pair benefits in conjunction with your FSA allowing you to get a back up pair of glasses or prescription sunglasses at a great price.

Eyeglass Accessories

Accessories and cleaning products are also covered so stock up on your microfiber cloths, sprays and moist towelettes! Get an estimate with your insurance benefit, then deduct the amount that your FSA covers. Ask for several options in order to maximize your benefits. Always get a quote on what you want to get and then make a decision once all benefits and FSA monies are applied. 

Finally, don’t forget to call ahead of time if you want to schedule appointments for the whole family on the same day!

Sylvia FishGuest Post By: Sylvia Fish