Routine eye exams can uncover serious health concerns, many of which can be costly to manage and detrimental to one’s health. However, many employees are reluctant to undergo routine vision checkups simply due to the cost. To encourage your employees to have regular eye exams, consider offering vision insurance as part of your benefits package.
Many times, optometrists can detect conditions such as diabetes, hypertension, and high cholesterol before your employee or his or her primary care doctor is even aware of any such concerns.
- Diabetes: Causes diabetic retinopathy, which can lead to vision problems if it is left untreated. Optometrists can easily identify diabetes when examining the blood vessels of the eye—one of the symptoms is bleeding in the back of the eye.
- Hypertension: Optometrists can detect hypertension by looking at how the blood vessels of the eye cross one another. If certain patterns become evident, high blood pressure is likely the cause.
- High Cholesterol: This condition causes plaque to get stuck in the forks of the blood vessels in the back of the eye.
Vision Care and Your Business
Vision care is not only essential to the health of your employees, it is also vital to your business. Employees at any age can experience vision-related health concerns that may impact your health plan budget and infringe on their productivity. Workers of all ages may experience vision stress, which can lead to constant headaches, the inability to focus, blurred vision, and a loss of concentration, according to the American Optometric Association. However, by offering vision insurance benefits to employees and encouraging them to take advantage of the benefits and to maintain consistent care, they can reduce their risks of developing the conditions listed above.
Types of Group Vision Insurance Plans
Vision insurance plans are designed to provide routine preventive care, such as eye exams, eyewear, and other vision services at a reduced rate. This benefit is typically offered in one of two forms for employees:
- Offered through a vision benefits package: Provides vision care to employees in exchange for an annual premium or membership fee, yearly deductible, or copayment.
- Offered through a discounted vision plan: Provides vision care at a fixed reduced rate after members pay an annual premium or membership fee and deductible.
Employees typically pay for the benefit through a payroll deduction. Plan design options generally include the following:
- Annual or biannual eye exams (including dilation) covered in full.
- Eyeglass frames and lenses (glass or plastic; single vision; lined bifocal and lined trifocal). The amount covered depends on the plan. Additional pairs along with scratch-resistant coating are also design options.
- Contact lens services. The amount covered and whether lenses are included depends on the plan.
- Plan design value-added benefits may include a primary eye care program, laser vision care program, and a low vision program.
- Laser vision care programs generally include coverage levels for a complimentary screening, pre-operative exam, surgery, post-operative exams, and enhancement follow-up surgery.
- Other design options include computer vision care and safety plans that provide members with prescription eyewear that is in compliance with ANSI and OSHA safety guidelines. Common exclusions include replacement of lenses, frames, or contacts, medical or surgical treatment, orthotics, vision training, experimental vision services, treatments, and materials.
In addition to these services, employees may take advantage of online tools with access to local eye doctors, ways to manage eye pain, and information concerning how vision health affects the entire body.
Health Care Reform Implications
The Affordable Care Act (ACA) imposes new requirements on group health plans, including certain vision benefit plans. Depending on the vision insurance plan that you offer to employees, you may be required to comply with certain ACA provisions, such as coverage for adult children up to age 26 and the elimination of lifetime and annual limits.
In general, plans that are not subject to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) portability rules are also not subject to the ACA. These plans are known as “excepted benefits.” Included in the excepted benefits category are “limited-scope vision benefits.”
Vision benefits that are of limited scope are not subject to the ACA’s requirements if they are:
- Provided under a separate policy, certificate, or contract of insurance; or
- Otherwise not an integral part of the group health plan (whether insured or self-insured).
While only insured coverage may qualify under the first test, both insured and self-insured coverage may qualify under the second test. Under HIPAA regulations, vision benefits are not considered an integral part of a group health plan if the participant can elect not to receive the coverage and must pay an additional premium for the benefit if he or she does elect the coverage. This is the case whether the benefits are provided through the same plan or a separate plan. However, on Oct. 1, 2014, federal agencies issued a final rule that eliminated the requirement that participants pay an additional premium or contribution for limited-scope vision benefits to qualify as benefits that are not an integral part of a plan (and thus, as excepted benefits).
The Vision Insurance Payoff
According to a recent VSP® Vision Care study known as the VSP Eye Health Management Program, regular eye care yields a large payoff. The study required eye care professionals to report patient cases with early symptoms of diabetes, diabetic retinopathy, hypertension, corneal arcus (linked to high cholesterol), macular degeneration, and glaucoma. The study found that eye examinations uncovered diabetes 20% of the time, hypertension 30% of the time, and high cholesterol 65% of the time before the individual’s other health care providers detected the problems. Early detection of these conditions led to the following:
- Lower medical care and medication costs because later detection is typically much more costly.
- The cost for short-term disability, long-term disability, and workers’ compensation was lower when conditions were detected early.
- Individuals were more likely to remain employed a year after the condition was discovered because the health issue was easier to manage and required less treatment when discovered in its early stages.
Researchers concluded that for every dollar invested in vision insurance for eye exams, employers were reaping an additional 94 cents in value. The biggest savings resulted from the early detection of diabetes.
The one roadblock that employers face is trying to encourage their employees to utilize the plan once they are enrolled. Those who already have vision concerns may be actively utilizing their vision preventive care; however, many other employees may not be taking full advantage of this benefit. To promote your vision benefits, consider the following tactics:
- Educate employees about the importance of eye care through health workshops, luncheons, or fairs.
- Welcome, The DeHayes Group to your place of business to conduct a training session on the value of your employer-sponsored benefits, including vision insurance. This is also a great time for employees to ask questions about their offerings.
- Highlight the fact that your insurance benefits are deducted pre-tax. This means that employees will save more money if they enroll in your plan instead of trying to pay for the services on their own.
Connecting with your employees on the value of vision care and vision insurance is an integral part of maintaining a healthy workforce. By offering this benefit and subsequently encouraging individuals to utilize preventive eye care services, they may detect more dangerous conditions far earlier, which could save your organization money and positively impact your employees’ health.