Group Health Insurance – Vision

Vision benefits, have recently become less common in employer-sponsored benefit plans.  Some provincial health insurance programs include coverage for eye exams, while others include coverage to seniors or residents with physical disabilities. Vision coverage typically cover expenses related to eyeglasses (including lenses and frames) as well as contact lenses. Safety glasses and prescription sunglasses are typically excluded.
 
In recent years there has been a large increase in demand for laser eye surgery as the procedure has become more effective and lower in cost. Laser eye surgery provides an alternative for individuals who wear glasses or contact lenses for sight correction. Most insurers have revised their group contracts to include reimbursement for laser eye surgery under the vision benefit up to the maximum coverage available under the vision benefit.
 
Generally coverage is limited to a maximum amount payable as well as a limit on the frequency of benefits payable. The amount payable is typically in the range of $50 to $300. The frequency is generally limited to 12 or 24 months. Since these limits effectively control claims costs, vision benefits are not normally subject to the deductible or coinsurance feature of a health plan and the full cost of the maximum will be reimbursable.
 
There has been a recent trend of provincial governments shifting the cost of eye exams to employers with the delisting of coverage under the provincial health plan. In most cases, employers will offer some form of vision coverage either by explicit vision coverage, or through an allotment in a Health Spending Account which allows employees to purchase vision care products as eligible expenses.

Category: Group Benefits