Vision plans can cover a variety of services and procedures, including routine eye exams, framing and fitting glasses and lenses and diagnosis and treatment of eye diseases. Depending on the plan, vision insurance may cover services performed by ophthalmologists (medical doctors), optometrists, or opticians. Coverages vary, so employers should assess what level of coverage they want to proved based on employee needs and cost containment.
As with medical and dental care, vision care is usually covered by the these plans:
- Preferred Provider Organizations (PPOs)
- Health Maintenance Organizations (HMOs)
- Indemnity (no network, patient reimbursement)
Vision Expenses and Health Savings Accounts (HSAs)
Vision expenses are generally considered qualified medical expenses under a Health Savings Account.
Vision Plans and COBRA
COBRA (Consolidated Omnibus Budget Reconciliation Act) requires some employers to provide covered employees and their family members the right to continue group health benefits, including vision coverage, for a limited time after coverage would otherwise end. COBRA applies to employers who sponsor a group health plan, and have 20 or more employees on more than 50% of their typical business days in the prior year.
Vision Coverage and HIPAA
The federal Health Insurance Portability and Accountability Act (HIPAA) includes protections that limit exclusions for preexisting conditions, prohibit discrimination against employees and dependents based on health status, and allow special opportunities for individuals to enroll in a new plan under certain circumstances.
HIPAA does not apply to plans with "excepted benefits." Vision-only coverage may be considered limited-scope excepted benefits and, therefore, not subject to HIPAA if the benefits are offered under separate coverage or the benefits are not an integral part of the plan.
Special Update
For plan years beginning on or after January 1, 2015, final rules eliminate the requirement for participants to pay an additional premium for limited-scope vision benefits to qualify as benefits that are "not an integral part of a plan." In addition, in order to meet this criterion, such benefits:
- Do not have to be offered in connection with a separate offer of major medical or "primary" group health coverage under the plan
- Can be provided without connection to a primary plan, or the benefits can be offered separately from the major medical or "primary" coverage under the plan, as provided in the rules.