Welcome to ThreeFlow's benefit breakdown series, where we dive into the details of a coverage and discuss the most recent trends with the help of ThreeFlow's data and benefits experts.
We talked about vision insurance with underwriting consultant Jesse Faulk. With over fifteen years of experience as a benefits consultant and underwriter, he’s well-versed in vision coverage and options.
What’s vision insurance?
Vision insurance provides two primary benefits: coverage for exams and coverage for materials. Exam coverage generally includes routine comprehensive vision examinations and contact lens fittings. Materials coverage comprises three main categories: lenses, frames, and contact lenses.
How is vision insurance typically funded?
From a claims perspective, vision insurance is usually fully-insured, though self-funded options are also available.
For contributions, premium splits between the employer and the employee, and voluntary vision plans are standard practices.
What provisions are standard in vision insurance?
For lenses, plans that include material benefits generally cover single, bifocal, trifocal, and lenticular lenses in full. They can also provide coverage partially or in full for a variety of options including, but not limited to, lenses that are:
- Scratch Resistant
Our data shows that over 95% of plans offer a $10 copay for exams and over 50% offer a $25 copay for materials.
Standard provisions for frames include a maximum allowance, and a discount on any costs above the allowance, as long as an in-network provider is used. Standard provisions for contact lenses have a maximum allowance for elective contact lenses and can include a discount on any costs above the allowance. At ThreeFlow, we see over 50% of plans offering a $130 allowance for frames and contacts.
Most vision plans also include increased allowances or even full coverage for medically necessary contact lenses.
As for frequencies, our data shows that over 95% of plans cover one pair of lenses and one exam per year, and 70% cover a new pair of frames every two years.
Key takeaways for brokers when thinking about plan design?
For vision plan design, three primary decisions must be made:
- Exam and materials copay
- Frame and contact lens allowance
- Frequency of benefits
The best approach can vary based on contribution strategy, employer size, industry, etc. It’s important to consider all of these factors when coming up with the ideal plan design for a group, something for which our underwriting team is available for consultation.