Three Ways Brokers Can Enhance their Clients’ Vision Benefit

By David S. Karlin

While comparably lower in cost to other health benefits, employers are beginning to see the true value of offering a vision benefit. According to Kaiser Family Foundation’s 2017 Employer Health Benefits Survey, among the employers who provide health benefits, 47 percent of small firms and 82 percent of large firms offer vision benefits. In addition, employees are asking for it. The 2016 Annual Employee Perceptions of Vision Benefits survey conducted by Wakefield Research on behalf of Transitions Optical, found eight in 10 people chose to enroll in an employer-sponsored vision plan.

It’s obvious why more and more brokers are requesting vision benefits information today. We are experiencing historic lows in unemployment, causing the need for smart employee retention strategies. Employers and employees are touting the importance of vision coverage. But, how can you ensure these benefits are generating optimal ROI? Here are three ways of enhancing a client’s vision benefit program, at minimal cost, to improve a client’s vision benefits program.

  1. Expanding coverage for diabetics – According to the Centers for Disease Control and Prevention (CDC), more than 100 million people in the United States are diabetic or pre-diabetic. Diagnosed diabetes cases cost the U.S. $327 billion dollars per year, $90 billion dollars of this cost is in reduced productivity.  Diabetic Retinopathy is the leading cause of blindness in adults and can complicate eye diseases such as glaucoma and cataracts. Adding diabetic coverage can help manage diabetes complications resulting in a healthier employee and an improved bottom line for your clients. The cost of adding this benefit is about 1 percent of premium and diabetic coverage typically is comprised of the following:
  • Initial comprehensive eye examination including Dilated Fundus Evaluation, plus semi-annual eye examination follow-up;.
  • Diagnostic tests including gonioscopy, fundus photography (picture of back of the eye) and retinal scanning or imaging (laser scan of back of the eye) for those diagnosed with diabetes; and.
  • Data sharing of ICD-10 diagnostic codes with medical management intermediaries.
  1. Add coverage for polycarbonate lenses for children (19 and under) – Polycarbonate is a thin, lightweight and high-impact resistant lens with built-in ultra-violet (UV) protection and scratch-resistant coating. It is recommended for all children because they can keep up with their rough and tumble lifestyle and are shatter resistant. In addition, they are compatible with all eyeglass frame types. Adding this coverage will only increase benefit costs by 2 to 3 percent — minimal increase for a significant benefit increase for employees with children.
  2. Add a fixed specialty contact lens fitting fee – Due to advancements in contact lens technology, many people who previously could not wear contacts can now be fit for them. Today, approximately 25 percent of all new fittings are done for specialty contact lenses. Specialty contact lenses include Toric Lenses (correct for astigmatism), Multifocal Lenses (correct for distance and near vision) and Gas Permeable Lenses (provide correction for astigmatism and other conditions, where soft contacts are not appropriate).

The process of fitting specialty contacts to the patient requires more time from providers, often over multiple visits as compared to more traditional, standard lenses. Vision plans often require the patient to pay for specialty contact lens fitting fees at pricing that is frequently based on a discount on the provider’s retail price, which can exceed $100. You can add a fixed price maximum for this fee that is significantly below retail pricing and will not increase the cost of the plan. The change will also guarantee a uniform experience regardless of which in-network vision care provider is used.

Next renewal season consider these three vision benefit enhancements.  Your clients and their employees will be happy you did.



David S. Karlin is an insurance industry veteran with 30 years of management experience in vision and prescription drug plan administration. He currently serves as president of National Vision Administrators (NVA), Benecard Services, and Heartland Fidelity Insurance Company.