Can You Have Primary and Secondary Vision Insurance?

Vision insurance helps manage eye care costs, including routine exams and corrective eyewear like glasses or contact lenses. Many individuals wonder if it is possible to have more than one vision insurance plan, often due to various coverage opportunities available through an employer or a spouse. Understanding how multiple plans operate helps in making informed decisions about eye care coverage.

The Possibility of Multiple Vision Plans

It is generally possible to be covered by more than one vision insurance plan. This often arises when an individual has coverage through their own employer and is also a dependent on a spouse’s employer-sponsored plan, or when combining an employer-provided plan with an individually purchased one.

When an individual has multiple plans, one is typically designated as the primary insurer, paying first for services. The other plan acts as the secondary insurer. This structure is similar to how multiple health insurance plans function. While having dual coverage can offer more comprehensive benefits, it does not mean that total reimbursement will exceed the actual cost of services.

Understanding Coordination of Benefits

Coordination of Benefits (COB) is the process insurance companies use to determine which plan pays first when an individual has multiple vision policies. The purpose of COB is to prevent overpayment, ensuring that combined payments from all plans do not exceed the total cost of vision services received. This process designates one plan as primary and others as secondary.

Common rules dictate which plan is primary. For instance, the “birthday rule” often applies to children covered by both parents’ plans; the parent whose birthday falls earlier in the calendar year usually has the primary plan. Employer-sponsored plans typically take precedence over individually purchased plans, and active employee plans are often primary to retiree plans. Specific COB rules can vary by insurer and state regulations. Review policy documents or contact insurance providers directly.

Navigating Claims with Multiple Plans

When an individual has both primary and secondary vision insurance, the claim submission process involves a specific sequence. The claim for vision services must first be submitted to the primary insurance provider. This allows the primary plan to process its coverage.

After the primary plan processes the claim, it issues an Explanation of Benefits (EOB) document. This EOB details what the primary plan covered and any remaining balance. The policyholder then uses this EOB to submit the remaining balance to the secondary insurance provider. Maintain accurate records of claims, EOBs, and all communications with both insurers; this is important for smooth processing.

Assessing Coverage from Multiple Plans

Evaluating the combined scope of coverage from multiple vision plans involves reviewing each policy’s terms. Examine what each plan covers, including allowances for frames, lenses, or contact lenses, and frequency limits. For example, one plan might cover an annual exam and glasses, while another might offer an allowance for contact lenses or specialty lenses.

Understand how combined premiums relate to potential savings. While dual coverage may lead to reduced out-of-pocket expenses, it also means paying two separate premiums. Compare the total cost of premiums against potential greater coverage or reduced out-of-pocket costs. The decision to maintain multiple plans should be based on a thorough review of individual vision requirements and the specific terms and conditions outlined in each policy.