Choosing your vision plan and utilizing the benefits is a little different than a small group health insurance policy. The insurance itself operates more similar to the dental coverage system, where a member receives specified coverage for certain expenses and then is responsible for the remainder of the expense. This is different than small group health insurance which covers you for medically necessary expenses after you've reached your annual max out of pocket limit.



Reading Your Benefit Description

Benefit descriptions may look something like this:

Exam……. $10 every 12 months

Lenses….. No charge every 12 months (single, bifocal, & trifocal only)

Frames…..$20 ($150 limit)

Contacts….$20($150 limit)

This benefit means you can receive an eye exam for either glasses or contacts, not both in the same 12 months, for the proper fitting and qualification of candidacy for type. Lenses come free with the glasses purchase so this is a pretty strong plan, but free for only specified types of standard fare glasses and only once a year. After you've paid your co-pay then for either glasses or contacts plus the co-pay for the office visit and examination you receive a $150 allowance towards your frames or contact lenses choice. Eye exams usually include vision problems, correction, and any visible health conditions.

Provider Network

If you have an existing eye doctor check to see what vision plan they accept prior to purchasing the small group vision plan for your employees. If you are new to the vision plan and don't have an eye doctor the contact the agent or vision carrier website immediately to find a contracted doctor in your neighborhood and make an appointment. This way you'll easily find a doctor maximize plan benefits.

Additional Savings and Discounts

Often times the California small group vision service plan will have additional benefits such as discounts for the expenses you incur beyond your allowance for glasses. Or, you may see discounting on laser correction surgery for contracted providers and items like scratch resistant coating.

Out of Network Reimbursement

To get the best value from your vision plan you should visit your contracted in-network doctors. If you happen to receive services out of network co-pays still usually apply, you just lose contracted rates for services and your annual benefit allowances are usually reduced. A 50% reduction or greater in benefit allowance is not atypical. You will be required to pay your provider at the time of service and file out of network claims form back to the vision plan carrier.

The Importance of Vision

Take care of your employees eyes. Vision accounts for the vast majority of our sensory input. Imagine a world without vision. Ignoring vision health problems can be devastating. Diabetes, macular degeneration, accidents, and a whole variety of conditions are out there so it's important to play it safe and make sure you receive routine eye exams and take care of any issues promptly. For more information visit our general overview section on Vision Care Plans.