Can You Have Two Vision Insurances?

Vision insurance helps manage eye care costs, including routine eye exams and prescription eyewear. These plans operate by charging a monthly premium for benefits that cover a portion of vision-related expenses. Unlike general health insurance, which often does not include adult vision care, dedicated vision plans help mitigate out-of-pocket expenses for services like eye exams, frames, and contact lenses.

Eligibility for Dual Vision Coverage

It is possible to have more than one vision insurance policy, often called dual coverage. This typically arises when an individual has vision benefits through their own employer and is also covered as a dependent under a spouse’s employer-sponsored plan. Another scenario involves combining an employer-provided vision plan with an individually purchased policy. While having two plans is permissible, benefits do not simply double; instead, the policies work together through a process known as coordination of benefits.

Dual vision coverage can offer increased financial support for eye care services, potentially reducing out-of-pocket costs. For instance, if one plan does not fully cover a service or item, the second plan may contribute towards the remaining balance. However, it is important to understand that dual coverage also means paying two separate premiums and potentially managing two deductibles or copayments. Reviewing the details of both plans is important to understand how they might interact and what additional costs could be incurred.

Principles of Benefit Coordination

When an individual has two vision insurance policies, their benefits are coordinated to determine how each plan will contribute to service costs. This process involves designating one plan as the “primary” insurer and the other as the “secondary” insurer. The primary plan processes and pays claims first, according to its coverage limits and rules. After the primary plan pays its portion, any remaining eligible costs are submitted to the secondary plan for consideration.

The determination of which plan is primary follows established rules. For instance, if an individual is covered by their own employer’s plan and also as a dependent on a spouse’s plan, their own employer-sponsored plan is usually considered primary. For dependent children covered by both parents’ plans, the “birthday rule” often applies; the plan of the parent whose birthday falls earlier in the calendar year (month and day) is designated as primary. This rule ensures a consistent approach to benefit coordination for families.

Coordination of benefits also includes provisions to prevent overpayment, ensuring that combined payments from both plans do not exceed 100% of the total service cost. Some secondary policies may also include a “non-duplication of benefits” clause, meaning they will not pay for services already covered by the primary plan, even if their own coverage limits are higher.

Submitting Claims with Dual Policies

When you have dual vision insurance policies, the claims submission process follows a specific sequence. The initial step involves submitting the claim to your primary insurance provider. Eye care providers often handle this directly, billing insurance companies on behalf of patients. The primary insurer then processes the claim according to its terms and benefits, paying its portion of the costs.

After the primary insurance processes the claim, they issue an Explanation of Benefits (EOB) document. This EOB details what the primary plan covered, the amount paid, and any remaining balance. You will need this EOB to submit a claim to your secondary vision insurance. The next step is to submit the remaining balance, along with a copy of the primary insurer’s EOB, to your secondary vision insurance plan. The secondary insurer will then review the claim and determine what additional portion of the cost they will cover, based on their own policy terms.

Required documentation for secondary submission includes an itemized receipt or statement from the provider that details the services received and the amounts paid. The EOB from the primary insurer is also a mandatory document. While many providers can submit claims electronically, some out-of-network claims or specific situations may require submitting paper forms. Always inform your eye care provider about both of your vision insurance plans at the time of service to facilitate a smoother claims process.