Understanding Your Vision Insurance Plan And Provider Network

If you are considering vision insurance plans, keep in mind not all plans offer the same benefits. They can vary significantly based on the number of optometrists and ophthalmologists in the plan’s provider network. Plans may also vary based on whether eye exams, eyewear, and other important services are provided at a discounted price or might be included as part of a benefits package.

Provider Networks

Eye care provider networks contract with vision organizations to offer eye care services at discounted costs for beneficiaries, which can take several forms:

  • HMO (Health Maintenance Organization) – Participants will be required to obtain services just from network providers.
  • PPO (Preferred Provider Organization) – While participants will be allowed to see out-of-network providers, it will cost them more.
  • When vision insurance is included in an indemnity insurance plan, you can use any provider you like.
  • When vision insurance is purchased directly from your insurer, you typically have a PPO plan.

Assessing Your Eye Care Provider Network

Whether you are studying your provider network for you or for your employees, make sure you consider the following:

  • Do they have network providers close to your home or work?
  • How long they make you wait for an appointment?
  • How long you must travel to visit your provider?
  • Is your current eye doctor a member of the network?
  • What do people say about the providers?

If you were able to answer these questions, you should have enough information to determine whether a provider network is good for you or not.

Vision Benefits Packages

Vision benefits packages provide participants with certain eye care services where a membership or annual premium is required. Basic coverage includes a comprehensive eye examination and a pair of either contact lenses or eyeglasses. There may be allowances for designer frames and specialty lenses.

A deductible may be required. This is a minimum dollar amount before coverage kicks in. Limits are generally set based on the number of times a participant access a service during the provided coverage period.

Some vision benefits packages may provide allowances for other things you may need. These can be accessed via out-of-network providers.  When a participant requests a given service from an out-of-network provider, they usually pay in full and then request a reimbursement from the insurer.  

Premiums or membership fees can vary depending on the level of coverage you are seeking, whether that is full service, eye exam, and other related items. If you purchased an individual vision plan, you would pay higher premiums since you didn’t take advantage of group coverage offered through an organization.

Vision insurance makes it all more affordable. Request a quote here.

  • https://marketplace.cms.gov/outreach-and-education/what-you-should-know-provider-networks.pdf


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