Many people assume that dental and vision insurance fall under a good health insurance plan. In some cases, this is true; but this is not always the case. Speaking with your insurance agency will help you to be more informed on exactly which plans are offered and which ones you are currently covered on. Just because a person has medical insurance does not mean that he or she also has dental and vision insurance. A person can also have dental and vision insurance without having medical insurance.

Some people will have access to vision insurance through their employer. Each health plan offered by varying companies differs in one way or another. One health plan may offer the option of the employee selecting medical insurance without having the option of dental or vision insurance. Another health plan through a place of employment may include medical, dental, and vision all in one package. And yet another health plan may offer three separate choices of medical, dental, and vision and allow the employee to pick and choose which ones he wants for himself and his family.

Taking the time to speak to your private insurance company and asking your human resources department at work about the available vision plans can help you to decide which type of vision plan will meet the needs of your family on the budget that you have to work with. There are basic and advanced vision plans that many insurance companies offer. Basic plans will typically include eye exams, contacts, and one set of glasses per year. Advanced vision plans can cover more serious treatments such as treating glaucoma and laser surgery.

A family vision insurance plan can be beneficial for everyone in the family, even if no one in the family currently wears glasses or has eye problems. Long term care on a consistent basis and regular eye check-ups can help to ensure that the members of your family are being well cared for in their vision area. Many times, issues will arise unexpectedly that will require a person to begin needing glasses or extensive eye exams. Vision insurance only costs a few dollars a month per person under most insurance plans and a vision policy, whether through a private insurance agency or through your work insurance, can help to protect and care for your family’s eye needs. This will be extremely beneficial on a long term basis and preventative check-ups can help to prevent more serious eye problems from occurring in the near or far future.

The calendar year always pertains to a 12 month cycle that begins January 1 and ends December 31.
Most plans have placed a set dollar limit which is defined as the “Capitation” regardless of how much or how little you use of the predetermined amount. This is what the provider pays for services rendered in a single calendar year.

The Carrier is defined as the HMO or the insurance company who offers the health plan.

Co-insurance is the amount “you” the insured pays after your deductible has been met. Usually your co-insurance is a percentage of that deduction. For example, 80 percent of the fee for medical services is paid for by your employer or insurance company, and the remaining 20 percent is your responsibility. Most plans have yearly deductible amounts as terms of the coverage.

A “Defined Contribution Plan” is when the employee contributes a certain portion of money each calendar year into his own personal employee account which is set aside to pay for medical expenses.
If an insurance company decides not to pay for medical care requested from the provider this is a “Denial (of the claim.)

Spouses and/or children of an insured person are defined as “Dependents”.

Any eye care services that are not covered under the vision called “Exclusions”.

FSH is an abbreviation for “flexible spending account” with provisions allowing an employee to use pre-tax dollars to purchase benefits which may not be covered in their plan such as vision or eye care benefits.
Generic Drugs are medications that are almost identical to brand name products. Once the patent on brand name medications has expired the generic makers of the same drug can market their products more competitively. Typically the generic drug is much cheaper and your health care provider will recommend you choose the generic over the name brand.

Vision insurance which is purchased by organizations like unions or businesses is known as “Group Vision Insurance” providing coverage for all individuals employed.

“HIPPA” is a federal law implemented in 1996, “The Health Insurance Portability and Accountability Act”, this law protects the privacy of medical records and places limits on sharing personal identifiable information. HIPPA allows you the insured to qualify for immediate and comparable coverage should there be a change in your employment status. Your eye doctor will provide you with documentation which should be signed to verify you are covered by the HIPAA guidelines.

HMO stands for “Health Maintenance Organization”. They provide pre-paid insurance plans where an individual or employee pays a fixed monthly fee for all services rendered instead of separately paying for each visit or service. Regardless of the level of service the monthly capitation always stays the same.
Health Savings Account (HSA) is a savings account set up in advance which is used to pay for health care and eye care with pre-tax income. You must have a high-deductible health insurance policy in order to open a HSA type account.

Individual Vision Insurance Eye Care Coverage is coverage sold to an individual instead of a group. Generally your membership fee will be a little higher.

IPA’s are an “Independent Practice Association” consisting of eye and/or health care providers. They are similar to HMO’s with the exception that you are seen in a private doctor’s office instead of an HMO facility.
Managed Vision Care is a management company that oversees the quality and cost of eye care services. Typically it is provided by an HMO or a preferred provider organization which includes independent eye doctors.

Membership Fees are your annual fees which keep your vision plan current.

Networks include individuals consisting of hospitals, doctors and health care providers agreeing to provide services for less than the usual fee.

Out Of Network In Vision Care are ophthalmologists and optometrists that do not provide for eye care services at discounted rates.

Outpatient Services are services provided that do not include overnight stays in hospital or medical facilities which may include LASIK and cataract surgery. Be sure to read your coverage carefully as many insurance companies will not cover the cost of certain tests or procedures unless performed on an outpatient basis.

PPOs are “Preferred Provider Organizations. These health care providers are established by an insurance company that provides health care for policyholders at discounted rates. If you choose a PPO your coverage will be at a higher cost.

Premiums are the annual fee you pay each year to keep your coverage current.

Primary Care Provider is the ophthalmologist or optometrist that monitors your individual eye care. They perform routine annual examinations and refer you to specialized doctors for additional care.

You can get either a group or an individual insurance policy. Group policies can be obtained through your company, or any other organization you work for. You can also obtain it through a government program such as Medicaid. Consult your company policy to know more about it.

If you want to purchase an individual policy (perhaps because you are self-employed, or your company does not offer individual vision insurance plans), you will be happy to know that most insurance providers sell separate policies for individuals.

Vision insurance is usually value added benefit to supplement a regular policy. It is available with both HMO (Heath Maintenance Organization) and PPO (Preferred Provider Organization) plans, and is contracted through a managed vision care network that provides eye care services.

As you may know already, in a HMO plan, you are obliged to take care from a select group of doctors, hospitals, and healthcare providers. It is a lot cheaper than PPO, but also a lot less flexible. A supplemental vision insurance policy under the HMO scheme limits your treatment option to a select group of care providers only.

The PPO scheme is a lot more flexible with fewer restrictions. Under this scheme, healthcare providers (doctors, hospitals, etc.) are contracted by the insurance company and receive a set fee for their work. The co-payment in PPO schemes is a lot higher (around 20% of the cost), but this is offset by the extra freedom.

It is obviously much more beneficial to get vision insurance under the PPO scheme, but the cost of such a policy can be quite restrictive. Your policy will usually cover the entire spectrum of eye care, such as routine eye exams by an ophthalmologist, eye tests done by an optometrist, eye surgeon, glasses, frames, and lenses, etc. The only difference is that with a PPO scheme, you are free to choose your providers, while under the HMO scheme, you will have to take up the doctor or eyewear store affiliated under the scheme.

Vision insurance cannot replace a regular policy. There is no financial reimbursement in case of any injury or damage to the eye. It only helps you pay for eye care and eyewear, and nothing else.

Usually, a policy allows for free treatment and checkups in return for a monthly or yearly fee that is added on to your current insurance plan. In some plans, you may have to pay a ‘deductible’ – a fixed dollar amount to be paid to the eye care provider.

Of course, an individual vision insurance policy can be custom designed to meet your needs.