Can You Have Two Vision Plans at the Same Time?
Explore the possibility of holding multiple vision plans and learn how to effectively coordinate them for enhanced eye care coverage.
Vision plans help individuals manage eye care and eyewear costs, covering routine eye examinations, prescription eyeglasses, and contact lenses. Many people wonder if it is possible or beneficial to have more than one vision plan simultaneously.
Having More Than One Vision Plan
It is generally possible for an individual to have more than one vision plan simultaneously. Common scenarios include coverage through one’s own employer, being covered as a dependent under a spouse’s employer-sponsored plan, or having a combination of employer-provided and individually purchased policies. For instance, a person might have vision benefits from their job and also be enrolled in their partner’s plan. This dual coverage can offer broader coverage or higher allowances for vision services.
Holding multiple plans often aims to maximize benefits. While having two plans does not mean benefits simply double, it can provide increased financial support for eye care services. This arrangement can be particularly advantageous if one plan does not fully cover specific needs or if more comprehensive eye care is desired.
How Multiple Vision Plans Work Together
When an individual has multiple vision plans, Coordination of Benefits (COB) determines how the plans interact to cover costs. COB ensures combined payments do not exceed the total service cost. One plan is designated as the “primary” payer, and the other(s) as “secondary”. The primary plan processes the claim first, paying benefits according to its terms.
After the primary plan processes the claim, the secondary plan reviews any remaining balance. The secondary plan may cover additional eligible costs, up to its own limits or the total allowed amount. General guidelines determine which plan is primary; typically, the plan covering the individual as an employee is primary, while a plan covering them as a dependent is secondary. For dependent children, the “birthday rule” often applies, making the plan of the parent whose birthday falls earlier in the calendar year primary.
COB aims to prevent duplicate payments while allowing the patient to maximize coverage. However, COB does not guarantee all out-of-pocket expenses will be covered in full. The member remains responsible for any remaining expenses after both plans have paid their respective benefits.
Using Multiple Vision Plans for Services
Multiple vision plans can be strategically applied to cover common vision services and products. Vision plans typically cover routine eye exams, prescription eyeglasses (frames and lenses), and contact lenses.
Individuals might use one plan for their routine eye exam and another for their eyewear, or combine allowances to cover higher-cost items. For instance, a primary plan might cover the exam and a portion of glasses, with the secondary plan covering remaining eligible costs. While multiple plans can offer more comprehensive coverage, coverage limits and allowances still apply. Plans often have restrictions on the frequency of purchases, such as allowing one set of lenses annually or one set of frames every year or every other year.
Filing Claims with More Than One Plan
When an individual has two vision plans, the process for filing claims typically begins by providing both insurance details to the eye care provider. Most eye care providers’ offices are equipped to handle the submission of claims to both the primary and secondary plans. This often means the provider will submit the claim to the primary insurer first, and once that claim is processed, they will then submit the remaining balance to the secondary insurer.
If the eye care provider does not handle both submissions, or if services are obtained from an out-of-network provider, the individual may need to submit claims themselves. To do this, individuals generally need to provide specific information, including the name of the provider, the patient’s name, the date services were received, and a complete description and amount paid for each service.
It is also advisable to notify both insurance companies about the existence of the separate plans to facilitate smoother processing. After the primary claim is processed, an Explanation of Benefits (EOB) will be issued, which may be needed when filing the claim with the secondary plan.