Can You Use Two Vision Insurance Plans?
Optimize your vision care by understanding how to effectively combine multiple insurance plans for better coverage.
It is possible to utilize two vision insurance plans. This arrangement is called Coordination of Benefits (COB), which manages how multiple insurance policies cover healthcare expenses. Dual vision coverage can provide broader protection and reduce out-of-pocket costs for eye care services and materials.
The Concept of Dual Vision Coverage
Coordination of Benefits (COB) in vision insurance determines the order in which two or more plans pay for services when an individual has multiple policies. COB ensures the policyholder receives appropriate coverage while preventing duplicate payments for the same service. One plan is designated as the “primary insurance,” paying first on claims up to its coverage limits.
After the primary plan processes the claim, the remaining eligible costs are submitted to the “secondary insurance.” The secondary plan reviews the balance and may cover costs not paid by the primary plan, according to its terms. This coordinated approach reduces the amount a policyholder pays for eye exams, glasses, or contact lenses. It ensures combined payments do not exceed the total service cost.
Rules for Designating Primary and Secondary Plans
Insurance companies follow rules to determine which plan is primary and which is secondary with dual vision coverage. A common guideline is that a plan from one’s own employer is primary over a plan obtained through a spouse’s employer. An individual’s own vision plan takes precedence over a parent’s plan for an adult child.
For children covered under both parents’ vision plans, the “birthday rule” applies. This rule dictates that the plan of the parent whose birthday falls earlier in the calendar year is the primary plan. The other parent’s plan serves as the secondary coverage. While these rules are widely adopted, specific plan documents and state regulations may vary.
Navigating Claims with Two Insurances
When seeking eye care services with two vision insurance plans, inform the provider’s office about both policies at the time of service. Provide both insurance cards, including policy numbers and identification details. This allows the provider to process the claim according to COB rules.
The eye care provider’s office handles claim submission. They first submit the claim to the primary insurance plan. Once the primary insurer pays its portion, the provider submits the remaining eligible balance, with an explanation of benefits (EOB) from the primary plan, to the secondary insurance. This sequential process ensures each plan contributes appropriately based on its coverage terms.
Financial Implications of Dual Coverage
Having two vision insurance plans can reduce out-of-pocket expenses. The secondary plan can help cover costs such as deductibles, co-payments, and co-insurance not fully covered by the primary plan. For instance, if the primary plan covers 80% of an allowable expense after a deductible, the secondary plan may apply its coverage to the remaining 20%.
Dual coverage can also extend coverage for annual maximums or limits on specific services, such as the allowance for frames or lenses. If the primary plan’s allowance is exhausted, the secondary plan might provide additional coverage. While dual coverage can lead to substantial savings, it does not result in zero out-of-pocket costs. Insurance policies include anti-duplication clauses, which prevent policyholders from receiving payments from multiple plans that exceed the total cost of the service.