Can You Use Two Insurances for Vision?
Optimize your vision care by learning how to effectively coordinate and utilize multiple insurance plans for maximum benefit.
Vision insurance helps individuals manage the costs associated with eye care, including routine examinations, prescription glasses, and contact lenses. Many people obtain vision coverage through their employer or purchase individual plans to protect their eye health. A common situation arises when an individual has access to more than one vision insurance plan, leading to questions about how these multiple coverages can be utilized.
Understanding Dual Vision Coverage
Individuals often find themselves with access to two distinct vision insurance plans through various common scenarios. One frequent instance involves coverage obtained through one’s own employer, coupled with additional coverage available through a spouse’s or partner’s employer-sponsored plan. Another common arrangement is a standalone vision insurance policy purchased directly by an individual, which may supplement a vision rider included within a broader medical insurance plan. Additionally, some individuals might hold two separate individual vision plans, perhaps from different providers, chosen for specific benefits or provider networks.
Having multiple vision plans can offer an advantage by potentially reducing out-of-pocket expenses for eye care services and materials. While it might seem like having two plans means double the benefits, the process is structured to coordinate payments rather than duplicate them. This coordination helps ensure that beneficiaries receive comprehensive coverage while preventing them from being reimbursed for more than the total cost of services rendered.
Principles of Coordination of Benefits for Vision
The interaction between two vision insurance plans is managed through a process known as Coordination of Benefits (COB). COB rules determine the order in which multiple insurance plans pay for healthcare services, ensuring that the total reimbursement does not exceed the actual cost of care. For vision insurance, this involves designating one plan as the “primary” insurer and the other as the “secondary” insurer. The primary plan is responsible for paying its portion of the claim first, according to its terms and conditions.
After the primary plan processes the claim, any remaining eligible balance can then be submitted to the secondary plan for consideration. Common rules dictate which plan is primary, such as the “birthday rule” for dependents covered by two parents’ plans, where the plan of the parent whose birthday falls earlier in the calendar year is primary. For individuals with their own employer plan and a spouse’s, their own employer plan is generally primary. The secondary plan will then review the remaining balance and pay according to its own benefits, deductibles, and co-insurance requirements.
For example, if a pair of glasses costs $200 and the primary plan pays 80% ($160), the remaining $40 would be submitted to the secondary plan. If the secondary plan covers 50% of the remaining eligible amount after the primary pays, it might pay an additional $20, bringing the total coverage to $180. The objective of COB is to minimize the patient’s financial responsibility.
Practical Steps for Using Both Plans
Utilizing dual vision coverage effectively requires identifying which vision plan is primary and which is secondary. Once this determination is made, communicate both insurance plans to your vision care provider before receiving services. Providing this information upfront allows the provider to correctly bill the primary insurer first.
After the primary insurer processes the claim, they will issue an Explanation of Benefits (EOB) document. You will then typically need to submit this EOB, along with a claim form, to your secondary vision insurance provider. The secondary insurer will use the information from the primary EOB to determine its payment responsibility for the remaining eligible charges.
It is also important to be aware of specific limitations that each plan might have, such as annual allowances for frames or contact lenses, waiting periods before certain benefits become active, or specific exclusions for certain services or products. For instance, many plans have an annual limit on eyewear, such as a $150 allowance for frames, or a waiting period of three to six months for major vision services like contact lenses. Understanding these individual plan stipulations helps manage expectations regarding out-of-pocket costs and ensures you maximize the benefits from both coverages.