Can I Have 2 Vision Insurance Plans?

It is possible to have more than one vision insurance plan. Many individuals are covered by multiple plans, such as through their own employer and a spouse’s employer. Understanding how these plans interact is important for eye care services.

Having More Than One Vision Plan

Individuals can have vision coverage from multiple sources. This includes personal employment benefits, coverage through a spouse’s or parent’s employer, or a privately purchased plan in addition to an employer-sponsored one. For instance, an employee might have a plan from their job and also be listed as a dependent on their spouse’s plan.

While holding multiple plans is possible, it does not typically result in receiving double benefits for the same service. The purpose is to maximize coverage for eligible expenses, not to profit from a claim. Instead, the plans coordinate benefits to ensure total reimbursement does not exceed the actual cost of the service.

Coordination of Benefits

Coordination of Benefits (COB) is the process by which multiple vision insurance plans work together to determine which plan pays first and how much each plan will cover. This mechanism prevents overpayment for services when an individual has more than one plan. One plan is designated as the “primary” plan, and the other as the “secondary” plan.

The primary plan pays its benefits first, as if no other insurance exists. After the primary plan processes the claim and pays its portion, the remaining eligible costs may then be submitted to the secondary plan. The secondary plan may cover additional expenses, up to its own limits, but the combined payments from both plans will not exceed the total cost of the service.

For dependent children covered by both parents’ plans, the “birthday rule” often determines which plan is primary. This rule states that the plan of the parent whose birthday falls earlier in the calendar year (month and day, not year) is considered primary. For example, if one parent’s birthday is in April and the other’s is in September, the April birthday plan would be primary. If parents are divorced, the custodial parent’s plan is typically primary.

Understanding Dual Coverage

Beyond the mechanics of Coordination of Benefits, holding two vision plans can offer an expanded scope of coverage. While COB prevents being reimbursed more than 100% for a single service, dual coverage can provide access to a wider array of services or higher allowances. For example, one plan might cover routine eye exams and a basic allowance for frames, while a secondary plan could offer better coverage for specialty lenses, contact lenses, or a higher frame allowance.

Different plans may have varying provider networks or specific covered services. Having two plans might allow for more choice in providers or access to different types of eyewear or procedures that one plan alone may not fully cover. For instance, if one plan has a limited selection of frames, the secondary plan’s allowance could contribute to a higher-priced frame. This can lead to more comprehensive overall coverage, reducing out-of-pocket expenses for a broader range of vision care needs.

Managing Multiple Plans

Effectively managing multiple vision insurance plans requires careful attention to each plan’s specific terms and conditions. Review details such as deductibles, co-pays, allowances for frames and lenses, and the frequency limits for services like eye exams or new eyewear, which might be every 12 or 24 months. Understanding these specifics helps maximize benefits from both plans.

Contacting both insurance providers directly is a practical step to confirm their Coordination of Benefits rules and clarify the process for submitting claims with dual coverage. Providers can guide you on how claims should be filed, typically requiring the primary plan to be billed first, followed by the secondary plan with the Explanation of Benefits (EOB) from the primary. Informing your eye care provider about both plans at the time of service is crucial for smooth processing. While managing two plans involves administrative effort, it can lead to greater financial support for eye care services and reduced out-of-pocket costs.