When Is Dual Vision Coverage Worth It?

Dual vision coverage means an individual is enrolled in two separate policies that provide benefits for eye care services. The primary objective of considering dual coverage is to enhance benefits and minimize out-of-pocket expenses for eye examinations, prescription eyewear, or contact lenses. This article will help determine if maintaining dual vision coverage aligns with an individual’s financial situation and vision care needs.

What Dual Vision Coverage Entails

Dual vision coverage involves holding active policies from two different vision insurance providers. This commonly arises when an individual has a vision plan through their own employer and is also covered as a dependent under a spouse’s employer-sponsored plan. Another scenario includes supplementing an employer-provided plan with a private, individually purchased policy.

Each plan has its own benefits, limitations, and financial structures, including premiums, deductibles, and allowances. While it might seem like double coverage, the process is more nuanced. The intent is not to receive duplicate payments but to ensure comprehensive coverage for vision services and products. This dual enrollment sets the stage for coordination of benefits, which dictates how the two plans interact.

Coordination of Benefits Explained

Coordination of Benefits (COB) is the process insurance companies use to determine which plan pays first when an individual has two or more vision insurance policies. This mechanism prevents overpayments. Understanding COB is essential for anyone considering dual vision coverage, as it defines how claims are processed and benefits are applied.

Typically, one vision plan is designated as “primary” and the other as “secondary.” The primary plan generally covers the individual as an employee, while a plan covering them as a dependent is usually secondary. In situations with two employer plans, the “birthday rule” (earlier birthday in the calendar year) or the plan that has covered the individual longer may determine primary status. Rules can vary by insurer and state.

When a vision care service is rendered, the claim is first submitted to the primary plan. This plan processes the claim and pays benefits according to its terms, including any applicable deductibles, copayments, or allowances. After the primary plan pays its portion, an Explanation of Benefits (EOB) is issued, detailing what was covered and any remaining balance. This EOB is then submitted to the secondary plan, which may cover eligible remaining costs up to its own limits, often reducing the patient’s out-of-pocket responsibility.

Evaluating the Financial Impact

Assessing the financial viability of dual vision coverage requires comparing combined costs against potential savings on vision care services. Individuals should begin by itemizing annual premiums for each vision plan, as these are recurring expenses. Next, examine the deductibles, copayments, and allowances for services like eye exams, frames, lenses, or contact lenses under both plans. Many vision plans have frequency limitations, such as covering new glasses or contacts only every 12 or 24 months, which impacts usage.

Estimate anticipated vision care needs for the upcoming year or two, including routine eye exams, prescription changes, or new eyewear. Calculate typical out-of-pocket expenses if relying on one plan, then project how the secondary plan might cover remaining costs after the primary plan pays. For example, if the primary plan offers a $150 allowance for frames, and chosen frames cost $250, the secondary plan might cover a portion of the $100 difference, depending on its own allowance and benefits. Compare the total combined annual premiums and any remaining out-of-pocket expenses with projected costs if only one plan were maintained. If the secondary plan’s benefits significantly reduce out-of-pocket costs beyond its premium expense, dual coverage may be financially advantageous.

Factors for Consideration

Beyond financial calculations, several practical elements warrant consideration for dual vision coverage. An individual’s anticipated usage of vision services is a factor; those with high vision care needs, such as frequent prescription changes, a desire for multiple pairs of glasses, or specific contact lens requirements, might find greater value in dual coverage. For instance, if one plan allows for contacts and the other for glasses within the same benefit period, this could maximize options.

The administrative effort in managing two plans should be weighed. This includes understanding the rules of each plan, informing providers about both coverages, and potentially submitting claims to both insurers. While many providers assist, some coordination may still fall to the individual.

Ensuring both plans are accepted by preferred eye care providers is important, as network restrictions can limit choices. Finally, features or limitations of each plan can influence the decision. Some plans might offer better allowances for premium lenses, anti-reflective coatings, or specific frame brands, while others may provide discounts on laser vision correction. Understanding these unique benefits and how they align with personal preferences and long-term vision goals contributes to a holistic assessment. Confirm that the plans’ coordination of benefits clauses do not prohibit or significantly limit the advantages of dual coverage for specific services.