Vision is one of the benefits employees notice most. They use it every year or two for exams and glasses. Yet many employers pick a vision plan without checking the network or the allowances. If you are comparing vision insurance in Bloomfield Hills, a few plain questions will tell you if a plan is any good.
We are an independent employee benefits consulting firm, in business since 2007. No carrier owns us. We help employers in Bloomfield Hills, Birmingham, Southfield, Pontiac and across Michigan choose vision coverage.
A group vision plan helps pay for routine eye care. That usually means an eye exam, plus help paying for glasses or contact lenses.
Two terms explain most plans. The first is frequency. That is how often an employee can use each benefit, such as one exam per year or new frames every other year. The second is the materials allowance. That is the dollar amount the plan pays toward frames or contacts. The employee pays anything above it. Compare the benefit with the premium in our free vision benefit value calculator.
Networks matter too. Some plans work best with large retail chains. Others have strong ties to independent eye doctors. Employees want to keep the eye doctor they already see. You can test your own figures with our employee plan comparison calculator.
We compare plans side by side and check the network against where your employees live and work. We explain the plan in plain words for open enrollment. For proper coverage of an account we work in teams of 5: an account executive, an account manager, a plan analyst, customer service and IT.
Both work. Vision is one of the lower-cost benefits, so some employers pay for it as a simple perk. Many others offer it as a voluntary benefit through payroll deduction. Employees who wear glasses tend to sign up. Those who do not can skip it. Either way, the plan gives your team access to network pricing. Our free lifestyle spending account budget calculator turns this into dollars for your plan.
Medical plans usually cover eye problems caused by an illness or injury. Routine exams, glasses and contacts are a different matter. Many medical plans pay little or nothing for them. Check your medical plan’s summary before you decide. A separate vision plan fills that gap.
A group vision plan is built for routine eye care. It is different from the medical plan, which handles eye disease and injury.
The plan pays for a periodic exam that checks vision and produces a glasses or contact lens prescription. Many plans charge a small copay. Employees should check how the exam fits with the lens and frame allowances, and confirm the exact copay before booking so there are no surprises at the counter.
The plan pays for a set of lenses, often with a copay and an allowance for add-ons. Lens type, such as single vision or bifocal, changes what is covered. Employees should ask which add-ons, such as scratch coating or tinting, fall under the allowance and which are paid out of pocket, so the lens choice matches the budget.
Frames usually get a dollar allowance. The employee pays any amount above it, sometimes at a discount. Employees should compare the allowance with the price of the frames they actually want before ordering. Some plans limit the choice to certain collections or retailers, so confirm which frames qualify and how any discount is applied above the allowance.
Contacts are usually offered instead of glasses, not in addition. The plan pays an allowance toward lenses and the fitting. Ask whether the allowance covers the fitting and follow-up visits in one amount or separately, and whether disposable lenses count the same as annual ones. Employees who wear contacts regularly should compare this with the frame allowance before choosing.
Many plans give member discounts on extras such as a second pair or laser vision correction. These are discounts, not insured benefits, and terms vary by carrier. Employers should not describe these discounts as covered benefits in enrollment materials. Ask the carrier to put the discount terms in writing so employees know which providers offer them and how long they last.
Vision plans generally do not treat eye disease. For how the two plans divide the work, see group health insurance.
The exam is the benefit most employees use, and it is where vision and medical coverage most often get confused.
Plans typically pay for one exam in each benefit period. The period is set by the plan, such as every 12 months. Employees should know whether the period follows the calendar year or the date of their last visit, because that affects when the next exam is covered. The benefit guide should state this plainly.
The plan may pay the exam in full or charge a copay. Ask for the figure and whether it applies to both exams and materials. A plan that pays the exam in full can still apply a copay to lenses or frames, so employees should read each line of the schedule separately. A one-page summary of copays helps people compare offers.
Some tests beyond the basic exam are not part of the routine benefit. The provider should explain any added charge before testing. Employees can ask for the price of any extra test before agreeing to it. Employers can help by reminding staff that the routine benefit and optional services are priced differently, which reduces surprise bills and calls to HR.
A contact lens fitting is often a separate fee from the exam. Many plans pay a fitting allowance, which differs by carrier. Employees who are new to contacts should plan for the fitting as a separate cost and ask the provider for the fee up front. Comparing the fitting allowance with the actual fee shows how much will come out of pocket.
Out-of-network, the plan usually reimburses a set dollar amount and the employee pays the provider first. Ask for the reimbursement schedule. Employees should keep the itemized receipt and a completed claim form, since reimbursement usually depends on both. Out-of-network use can cost more overall, so compare the reimbursement with an in-network provider’s price before choosing.
If an exam finds or treats a medical problem, the visit may be billed to the medical plan instead. See the section below for how this works. Employees should tell the provider at check-in whether they came for a routine exam or because of a symptom, and ask which plan the visit will be billed to. This helps avoid an unexpected claim on the wrong coverage.
Carriers describe how often benefits renew with three numbers. Understanding them helps you compare plan designs fairly.
The numbers usually stand for months between exams, lenses, and frames. A 12/12/12 plan renews all three each year. Employees on other schedules, such as 12/24/24, get new lenses and frames less often than they get an exam. Employers should confirm the schedule in the carrier quote and repeat it in the benefit guide so employees plan around it.
Exams and lenses renew yearly while frames renew every other year. This often lowers the premium compared with a plan that renews all three yearly. Employees who prefer to change frames often may find this design limiting, while those who keep frames for years may not notice. Employers should weigh the premium difference against how employees actually use the benefit.
Exams are annual while lenses and frames renew every two years. It is a common way to hold cost down. Employees who need a new prescription more often than every two years should know that lenses are not renewed in between. Employers can review how many employees use materials each year before choosing this design.
Some plans reset on January 1, others a set number of months after the last use. This changes when an employee becomes eligible again. Employees should check which rule applies before scheduling a visit. A date-of-service reset can mean the next benefit arrives later in the calendar than expected, so the benefit guide should explain the rule with an example.
Employers can ask for quotes at more than one frequency. We price the options so you see what each one costs per employee. Frequency is one of several levers, along with allowances and copays, that shape the premium. The right choice depends on budget and on how much employees value frequent frame and lens replacement.
These examples are common, not required. Ask each carrier to state its own design, because the rules differ. Comparing quotes means lining up the frequency, allowances and copays side by side, not just the premium. A quote with a lower price may simply renew lenses and frames less often.
Materials are where out-of-pocket costs build up. A plan that looks generous can still leave a bill if enhancements are not covered.
Single vision, bifocal, and trifocal lenses are commonly covered after a copay. Progressives are covered less consistently, so check. Employees who need progressive lenses should ask the provider for the cost before ordering and find out whether the plan applies an allowance or a discount. Employers should list the lens types covered in the benefit summary.
Coatings such as anti-reflective, scratch resistance, tinting, and photochromic lenses are often extra or partly covered. Some plans give set copays for them. Employees who want a particular coating should ask for the combined price before ordering. Because each enhancement may be priced on its own, the total can add up quickly, so a clear price list at the counter is worth requesting.
Thinner lens materials may be covered only in part. The employee pays the difference in many designs. Employees with strong prescriptions often choose thinner lenses for comfort and appearance. They should ask the provider whether the plan applies any credit toward the upgrade and what the final cost will be.
The allowance is a dollar amount per benefit period. A frame priced above it leaves the employee paying the difference, perhaps at a discount. Employees should shop with the allowance in mind and ask whether it applies to frames bought online or only in a store. Comparing the allowance with typical frame prices in the area helps set expectations before open enrollment.
Some plans fully cover frames from a collection chosen by the carrier. Ask what the collection includes and whether employees like the choices. Employees who choose from the collection may pay nothing out of pocket, while those who want other styles use the allowance instead. Employers can ask the carrier for a list of the covered brands to share at enrollment.
A second pair is usually not insured. Some carriers offer member discounts on it, which you should confirm. Employees should ask the provider about the second pair price and whether the carrier discount applies to it. Because these terms differ, employers should avoid promising a specific savings amount in enrollment materials.
Contacts are a different benefit from glasses, and the rules are less intuitive. Employees who wear them should know what applies.
Most plans pay for one or the other each benefit period, not both. Employees who want both usually pay for one themselves. Employees should decide before the visit which option suits them and ask the provider how the allowance is applied. Some plans let the unused portion go to the other item, so it is worth asking the carrier.
The plan pays a dollar allowance toward contact lenses. The allowance may be higher or lower than the frame allowance. Employees who wear contacts should compare the allowance with the yearly cost of their lenses, since a supply of daily disposables can use up the allowance quickly. Any cost above it is usually paid by the employee.
Some plans pay more when contacts are medically necessary, such as for certain conditions. The definition is set by the plan, so ask for it. Employees who think they qualify should ask the provider what documentation the plan needs and whether approval is required before ordering. Employers should have the carrier’s definition in writing so HR can answer questions consistently.
The fitting and follow-up visits may be included, discounted, or separate. Ask which applies. Employees should ask the provider whether follow-up visits for a new contact lens wearer are covered within the fitting fee. Knowing the answer before the first visit avoids paying twice for the same service.
Some carriers let employees order contacts online. Others pay only through contracted providers, so check how the claim works. Employees should read the claim instructions before buying online, since reimbursement may require a receipt and a form. Employers should check this with the carrier so the benefit guide tells employees exactly where to order.
The IRS includes eye exams and contact lenses among deductible medical expenses when the usual rules are met. Use HSA employee education for the account side.
The network decides how easy the benefit is to use. A strong network near your employees often matters more than a small difference in allowance.
Contracted providers charge copays and discounts set by the carrier. The employee usually pays little at the counter. Employees should confirm that their provider is in the network before the visit, because a provider listed under an old directory entry may no longer participate. A quick call to the office avoids a surprise bill.
The plan reimburses against a fixed schedule for exam, lenses, and frames. Reimbursement is often lower than the real price. Employees should ask the carrier for the schedule before choosing an out-of-network provider and compare it with the provider’s price. The gap between the two is the employee’s cost, so an in-network option may be cheaper.
Many employees value seeing their own optometrist. Check that the carrier network includes the practices your employees use. A short survey of employees, or a look at which eye doctors they already visit, helps test a network before you commit. Network lists change, so ask the carrier to confirm current participation for the practices that matter most.
Some networks include retail optical chains and big-box stores. Others include them only at specific benefit levels. Confirm which locations are covered. Employees who prefer a retail location should check whether it is covered at the benefit level the employer chose. Pointing staff to the carrier’s provider search at enrollment helps them see which stores and offices participate.
Some carriers let employees buy glasses or contacts online using the benefit. Terms vary, so ask for the specific site and any limits. Employees who like to shop online should check whether the site accepts the benefit at checkout or only reimburses afterward. Employers should note any limits on frames or lenses in the benefit guide so expectations are clear.
If employees live in more than one state, confirm network strength where they are. We do this check before recommending a plan. Employees who work in other states may find fewer participating providers near them. Employers with remote staff should ask the carrier how its network looks in those areas and whether out-of-network reimbursement is workable.
Eye care splits between two plans. Knowing the line helps employees avoid denied claims.
A checkup with no medical problem is usually a vision plan claim. It produces a prescription for glasses or contacts. Employees booking a routine checkup should say so when scheduling, so the office bills the vision plan. Employers can include a short note in the benefit guide about which plan to present at the visit.
Conditions such as infections, glaucoma, cataracts, or dry eye are generally medical. The deductible and coinsurance of the medical plan apply, per optometry schools such as UAB. Employees with a symptom, such as eye pain or sudden changes in vision, should expect the visit to be billed to the medical plan. Employers can explain this in the benefit guide to prevent confusion at the front desk.
Employees with diabetes may need eye exams to check for related eye disease. Whether the exam is billed as routine or medical depends on the diagnosis and the plans, so confirm. Employees with diabetes should ask their eye doctor how the visit will be coded and which plan will be billed before the appointment. The answer depends on the diagnosis, so the provider’s office is the best place to confirm it.
A single appointment can include routine and medical work. Providers sometimes bill each part to the right plan, and the employee may owe two cost shares. Employees should ask the office to explain how the visit will be split between the two plans before they leave. Getting the breakdown up front makes the two cost shares easier to expect and to check against the later statements.
A medical-billed exam usually does not produce a glasses benefit. Employees may need a separate routine exam. Employees who need glasses after a medical eye visit should plan a separate routine exam to get a prescription under the vision plan. Asking the office whether it can schedule both visits helps avoid a gap, and employers should mention this in the benefit guide.
A short note on which plan covers what can prevent confusion. For the medical side, see summary of benefits and coverage explained.
Federal rules treat vision for children as an essential health benefit. How that applies to an employer plan depends on the type of plan.
Pediatric vision care for children under 19 is one of the ACA essential health benefits, according to Prevent Blindness. Employers should not assume the medical plan covers a child’s vision care in the way the vision plan does, because the rules differ by plan type and state. Ask the carrier how pediatric vision is handled and how it fits with the group vision benefit.
Prevent Blindness reports that most states use the federal employee vision program as the benchmark, which includes an annual exam and glasses. Each state may differ. Employers should ask the carrier what its medical plan provides for pediatric vision and whether a separate group vision plan duplicates or improves on it. The answer helps employees understand which benefit to use for a child’s exam and glasses.
The essential health benefit rules apply to individual and small-group medical coverage. HHS has said self-insured and large-group coverage is not required to cover them. Employers in those groups should ask their carrier or adviser how pediatric vision is handled for their own plan, since the rule does not automatically apply. A stand-alone vision plan is one way to make sure children have a defined benefit.
Employers that offer vision to dependents give children access to exams and glasses through the group plan. Ask what dependent premiums look like. Employers should compare the added cost of covering dependents with how many employees have children and would use the benefit. A quote that shows employee-only and family rates separately makes that comparison easier.
Children can generally stay on a plan to a stated age. The plan documents set the exact rule. Employees should check the plan’s age rule for dependent children and what happens at the cutoff, since the date can fall mid-year. Employers should repeat the rule in the benefit guide so parents are not caught off guard.
Ask your carrier whether any benefits differ by age, and consider a short note at enrollment so parents know what the plan offers. Children often need eye exams early, so parents benefit from knowing what the plan covers for them before the first visit. A brief explanation in the enrollment packet and a reminder about the benefit period can make the benefit easier to use.
Eyewear is one of the easiest uses of a tax-advantaged account, but the rules differ by account type.
IRS Publication 502 lists eye exams, and eyeglasses and contact lenses when needed for medical reasons, as medical expenses. Plan administrators set the rules for specific items, so confirm. Employers who offer a health FSA or HSA can point employees to the plan administrator for the list of eligible items. Employees should keep itemized receipts, and a tax adviser can answer questions about a specific purchase.
Whether these qualify depends on the account administrator and the medical-necessity rules. Ask the account provider before spending. Employees often assume these items are eligible because they relate to eyesight, but the rules can be narrower. A written answer from the account administrator before the purchase is safer, and a tax adviser can help with unusual cases.
IRS Publication 969 says people with an HSA-eligible plan can also hold separate vision coverage and keep HSA eligibility. Employers should still confirm with their tax adviser or benefits counsel how vision coverage fits alongside the specific high-deductible plan they offer. Plan design details matter, and the carrier can confirm what its documents say.
A limited-purpose FSA can pair with an HSA and reimburse dental and vision expenses. It is a common companion to a high-deductible plan. Employers who offer both accounts should explain in plain terms which expenses each account pays, because employees often confuse them. The plan administrator can supply the exact rules, and a tax adviser can answer questions on eligibility.
The account can reimburse the out-of-pocket costs, such as copays and amounts above allowances. Employees should keep their receipts. Employees can use the account to cover the difference between the allowance and the actual price of glasses or contacts, where the rules allow. A simple reminder at enrollment to save receipts makes claims easier later.
Use HSA employee education for a fuller look at how accounts work.
Vision is one of the lowest-cost benefits to add, which makes it a common voluntary offering.
The employer pays all or part of the premium. It is a visible benefit that many employees use every year. Because the benefit is used so often, employers often find that employees notice it more than other voluntary options. Deciding how much of the premium to pay, and whether dependents are included, is a budget choice that can be quoted at several levels.
Employees pay at group rates through payroll. The employer carries administration, not premium. See voluntary ancillary benefits.
Carriers may require a minimum enrollment, especially for voluntary plans. Confirm the requirement before you offer the plan. Employers with small groups should ask whether the minimum is a number of people or a percentage of eligible employees. Knowing this early helps decide whether to offer a voluntary plan or an employer-paid one.
Many carriers allow a group to add vision at any time, subject to their rules. We confirm effective dates with the carrier. Employers adding vision during the year should ask about waiting periods, enrollment windows for employees, and whether the group must run a special enrollment. Planning the communication to staff early helps employees use the benefit right away.
Vision can come from a different carrier than medical, which gives you more choice. See also group dental insurance.
A Michigan small-group plan can start in any month with as few as one W-2 employee, and an employer contribution is not required. Carrier rules on vision participation can still differ, so we check before quoting. Asking about participation and contribution rules early keeps the vision decision from slowing down the medical timeline.
Laser procedures are usually not part of the insured vision benefit, though some carriers offer member pricing.
Where offered, laser vision correction is typically a discount through a contracted network, not an insured payment. Confirm the carrier terms. Employees should be told that the discount applies only through participating providers and may not combine with other offers. Employers should avoid describing it as coverage in enrollment materials.
The IRS treats laser eye surgery to treat defective vision as a medical expense. That makes it a possible use of an HSA or FSA, if your plan allows. Employees should ask the account administrator whether the procedure qualifies before paying, and keep the provider’s invoice. A tax adviser can confirm how the rules apply to a particular case, since the answer can depend on the facts.
We cover laser vision correction in detail, including how employers handle it, in our LASIK and laser vision correction employer guide.
Network availability and discounts change over time. Ask for current terms rather than relying on a marketing sheet. Employees who plan a procedure should ask the carrier or provider for the discount in writing at the time of scheduling. Employers can set a reminder to review the program terms with the carrier at each renewal.
An eye care professional decides whether a person is a candidate. The benefit does not replace that judgment. Employees interested in a procedure should schedule a consultation with a licensed eye care professional before assuming it is right for them. Employers should present the discount only as a way to reduce the cost once a provider has approved the plan.
Treat any discount as a perk, and do not promise it to employees as covered care. Enrollment materials should describe it as an optional savings program and direct employees to the carrier for current terms. This keeps expectations realistic and avoids complaints if a provider or discount later changes.
Vision follows some of the same rules as dental. A few points are worth checking before you finalize your plans.
The Department of Labor says COBRA can continue dental and vision care. Employers with at least 20 employees generally must offer it. Employers should check whether their vision plan is subject to COBRA and what the notice process requires. State continuation rules may also apply to smaller groups, so confirm the requirements with counsel or the carrier.
Employees have at least 60 days to elect, coverage can run up to 18 months after a job loss, and the plan can charge up to 102 percent of its cost.
Federal rules treat limited-scope vision as an excepted benefit if it is a separate policy, or if employees can opt out and claims run under a separate contract. Whether a vision plan meets this status depends on how it is written and sold, so the carrier’s documents matter. Employers should ask the carrier or counsel to confirm which structure applies before relying on the label.
Excepted benefits sit outside many ACA mandates for medical plans. Your advisor can confirm how this applies to your setup. The practical effect is that vision coverage is treated differently from the major medical plan for several rules, though some requirements still apply. Employers should ask counsel or their adviser which rules reach their own vision plan.
Plan documents and notices apply even when a benefit is excepted. See reading your plan documents.
We explain the rules and help you ask good questions. Counsel should confirm legal requirements for your group.
These are the points we ask each vision carrier to state in writing so proposals can be compared fairly.
Ask for exam, lens, and frame frequency and how the benefit period resets. Frequency drives how often employees can use the benefit and how the premium compares. Ask whether the period follows the calendar year or the date of service, and have the carrier put the answer in writing in the quote.
Get the dollar allowances for frames and contacts, and which lens enhancements carry fixed copays. Allowances decide how much employees pay out of pocket. Ask whether they apply per benefit period, whether unused amounts carry over, and how much of the cost of common add-ons falls on the employee rather than the plan.
Ask for providers near your employees, including retail and online options. A network is only useful if employees can reach it. Ask for a provider search by ZIP code for the areas where your staff live and work, and confirm that the practices employees already use are participating.
Request the full reimbursement schedule, since this is where plans differ most. Employees who go out of network may be reimbursed far less than they paid, so the schedule is worth reading carefully. Ask how claims are filed, how long reimbursement takes, and whether any amounts are paid on the employee’s behalf.
Get the length of the guarantee and what could change the rate during that period. A rate guarantee protects your budget only for the stated period. Ask what events, such as a change in enrollment or in contribution levels, can reopen the rate, and how much notice the carrier gives before a renewal.
Ask how in-network and out-of-network claims are filed, and where employees get help. See denied claims and appeals.
Yes. Vision is often a separate plan. Some medical carriers offer vision as part of a package, so we compare the bundled option against a stand-alone plan on network and allowances before recommending either. Comparing bundled and stand-alone vision finds the best fit.
Most group vision plans let employees cover a spouse and children. Rates are usually set by tier, such as employee only, employee plus spouse, employee plus children and family. Children’s eligibility ends at an age the plan defines, so check the certificate.
Many employers add it at open enrollment in the fall. A new vision plan can also start at other times of the year. Once it is in place, employees generally cannot join or drop mid-year unless they have a qualifying life event.
Usually it does not. Most vision plans offer a discount through a network of surgeons rather than coverage, and the discount varies by plan. See our LASIK guide for how HSAs and FSAs can help.
Plans commonly allow an exam once every 12 months, with lenses and frames on the same or a longer cycle. The schedule is set by the plan and the carrier, so compare it before you choose.
No. A vision plan pays set allowances and copays for exams, lenses and frames. A discount program only lowers prices at participating providers and does not pay claims.
Many plans allow out-of-network visits at a lower reimbursement. The size and mix of the network, including retail and independent providers, matters more than the headline benefit.
Medical coverage handles eye conditions such as infections or glaucoma. Routine exams, glasses and contacts come from a separate vision plan or rider.
Send us your renewal or book a 30-minute call, and we will compare vision insurance in Bloomfield Hills for your team. Visit us at 41000 Woodward Avenue, Suite 350 East, Bloomfield Hills, MI 48304, or call 248.370.8853.
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Related reading: LASIK and laser vision correction
Allowances, frequency and what the premium buys.
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Requires many group health plans to offer temporary continuation coverage after a qualifying event.
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Tax rules for health savings accounts paired with qualifying high-deductible health plans.
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