Q&A: Vision Insurance Top Questions Asked by Businesses and Administrators

Health Plan Shopping Q&A

We've rounded up the top 3 questions small business owners, HR professionals, and plan administrators ask about Vision insurance. To find and shop for vision plans for your business, visit our Health Insurance Marketplace. 1. Will employees be charged a copay in order to use their vision insurance? In short, it depends. Insurance providers are free to charge a copay if they choose to do so. The answer to this question will be entirely dependent on the insurance provider and plan your company has chosen.

Federal Regulations

Under the Affordable Care Act (ACA),insurance providers are only barred from charging copays for certain preventative services, like cholesterol screenings or vaccinations. In all other respects, they are free to charge an appropriate copay for medical services, including vision coverage.

State Regulations

States often have additional regulations for copays, typically related to the maximum allowable amount, and the types of procedures that are allowed to have a copay applied. However, since adult vision coverage is not usually a required component of health insurance coverage, it’s very unlikely that a given state will have laws forbidding copays.

To find out what your company’s state regulates for copays, a simple search for “copay regulations” and the state name should yield results. For example,Wisconsin provides a primer for copay regulations, which has no special provisions for optometry copays.

Because insurance providers are generally free to charge copays for vision coverage, you’ll need to check with your company’s insurance provider to find out if employees will be responsible for a copay for vision insurance.

2. Most of my employees don’t wear glasses; is vision insurance a benefit I should be offering?

Short answer-yes, it is. Vision is crucial to the overall health of employees even if their eyesight is 20/20.

Are you sure your staff don’t wear glasses?

The first thing to consider is, how do you know your staff doesn’t wear glasses? It seems likely that a high proportion of them will require some form of vision correction–roughly half the population does, according to the National Association of Vision Care Plans, as do 80 percent of those over age 45. Also, if your staff is spending two hours or more per day working on computers, they are at significant risk of suffering from vision problems associated with digital eyestrain.

Vision plans are not just about eye health

The second thing to note is that vision plans are not just about eye health. During a routine eye exam, eye doctors may detect other serious health conditions, even when the patient is not experiencing any symptoms. These conditions include:

    • diabetes
    • cancer of the eye
    • glaucoma
    • hypertension
    • high cholesterol
    • multiple sclerosis
    • increased risk of stroke and heart disease

Failing to provide vision benefits might delay access to medical care for these conditions, which can lead to increased absenteeism and higher health care costs in the future.

Which leads us to the third point–vision plans can have a serious positive impact on your bottom line.

The financial impact of vision health

Each year, vision disorders account for more than $68 billion in direct healthcare costs and lost productivity, macular degeneration, cataracts and glaucoma increase significantly in those over 40 ) across the United States. Even slight vision problems can reduce productivity by up to 20 percent. That’s because workers with poor vision typically require additional time to complete tasks and may put out a decreased quality of work. Productivity is of particular concern among older workers, as the risk of presbyopia (trouble focusing on objects at varying distances.

The cost of providing preventative eye care? Vision coverage remains a cost-effective benefit, especially when compared to annual premiums for an employer-sponsored health plan. For instance, annual dollars** per employee for a premium vision benefits package typically falls within the **$150-$200 range, depending on the plan you choose and your state of residence, compared with $6,025 for single coverage medical insurance.

For these and other reasons, it’s worth including vision as part of the healthcare discussion even if your workers are apparently blessed with perfect vision.

3. Does my company need to offer vision coverage under the Affordable Care Act (ACA)?

In short, no. Your company is not required to offer vision coverage for adults under the ACA.

What is Vision Pediatric Coverage?

While you’re not required to offer vision coverage for your adult employees, you may be required to provide it for any children under 19, including family members of your employees.

Your company is allowed to have a “grandfathered” plan that wasn’t purchased through a government marketplace if your business has more than 50 employees, but “small group” plans for companies with fewer than 50 employees are subject to the standard of “essential health benefits” set out by the ACA, and that includes pediatric vision.

Small group health plans that are ACA compliant now include pediatric vision. This meets the requirement for offering vision to children. However, many plans include the option of adding vision coverage for adult employees, and your company is free to purchase those plans if it wants to do so. In addition, offering vision coverage can boost employee well-being by enhancing employees’ ability to take care of their eyes and make your company a more desirable place to job applicants who assess a company based on the variety of benefits that the company offers.

Helpful Links:

ACA Business Answers – Get answers to common small business owner questions about the Affordable Care Act.

Small Business Insurance Marketplace – Find out what options small businesses have for purchasing insurance.

Services Exempt from Copays– Find out what preventative services are exempt from copays under Federal law.