HR ADVISOR


Can an employee use vision insurance to pay for laser eye surgery?

Generally, most insurance providers consider laser eye surgery (often referred to by the brand name LASIK) to be a cosmetic surgery and do not cover it for any plan, including employer plans. Indeed, insurers aren't required to provide even basic vision care for adults under health insurance regulations, so "extras" like laser eye surgery are even less likely to be included in a plan.

Special Circumstances:

In some cases, an employee can negotiate directly with the insurer to make the claim that their job requires special consideration for laser eye surgery. If your employee is a member of the armed forces (through the National Guard or a similar arrangement), plays sports professionally or is a professional entertainer, then they may have a chance at securing coverage for the procedure.

In each case, your employee will need to contact the insurer themselves to negotiate a special arrangement.

Insurer Discounts:

Even when direct coverage isn't offered, some insurers provide discounts to the out-of-pocket costs your employee must pay, often as part of a special arrangement with specific care facilities. To find out whether this is the case, your employee should contact both the medical facility they plan to use for laser eye surgery and the insurance provider. For example, Aetna's website for vision coverage makes it clear that they offer a discount program for laser eye surgery.

To find out whether your carrier offers a similar program, a simple internet search for "laser eye surgery" or "lasik" and the name of your carrier should yield an answer.

Flexible Spending Accounts:

Your employee can also use their FSA to pay for eye surgery, including laser eye surgery.

Conclusion:

In summary, it's unlikely that your company's insurance will directly cover laser eye surgery. To help your employee defray the costs of the procedure, work with them to determine whether an agreement can be negotiated with the insurer based on their job duties, or whether the insurer or the employee's chosen optician has arranged a discount program. Alternately, work with them to ensure they're contributing an appropriate amount to their FSA to help pay for the procedure that year.

Helpful Links:

Marketplace Health Plans - Find out what plans in the Federal Health Insurance Marketplace cover.

Flexible Spending Accounts - Find out how an FSA can be used to cover health costs.

LASIK Costs - Find out how much LASIK typically costs to help your employees prepare for the expense.

Karen Gracey
Manager, Benefits Advisors
Posted on Aug. 6, 2015, 5:43 p.m.
Disclaimer: The answers and information on HR Answers serve as basic guidelines and are for informational purposes only. While our goal is always to provide useful content, we are unable to provide legal, tax, or fact-specific human resources advice and encourage you to speak with your legal counsel, tax advisor, or human resources professional to understand how this information applies to you.