Vision Coverage Plans
- Designed to cover routine eye care services for healthy eyes, such as periodic eye examinations and refractive services (the determination of a final eyeglass prescription), and contact lens fitting services
- Often provide benefits for materials, such as eyeglasses or contact lenses
- Plans vary greatly and pre-approval is usually required
Medical Insurance
- Designed to cover medical eye care services such as evaluation and management of eye emergencies or disease
- Covers eye exams for people with certain medical conditions such as Diabetes, or on certain medications such as Plaquinil, Amiodorone, or Methotrexate. If you need an eye exam due to one of these conditions, your medical insurance will be billed for the examination, but the refraction and materials may still be covered by your Vision Plan, based on the plans policy
- Often covers diagnostic testing, such as imaging, visual fields, OCT’s, or other specialized testing as needed to aid in medical diagnosis or treatment (does not cover Wellness Exam screening)
- Does not cover routine eye care for nondiabetic patients with no medical related complaint (such as just need new glasses), except sometimes for children.
- Does not cover the refraction (the determination of the final eyeglass prescription). This fee will be collected at the time of visit if a refraction is performed.
- Does not cover eyeglasses or contact lenses except for rare special medical circumstances, unless you have a Health Savings Account (HSA) or Flexible Spending Arrangement (FSA)
- Usually requires a copay or deductible, which must be collected at the time of service.