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Millions of Canadians leave extended health benefits unclaimed. We all know (or at least we should) that these health benefits expire and renew in a given period. 

Whether you’re getting health benefits through work or a personal insurance plan, you’re paying for your coverage regardless if you make a claim or not. 

As we all know, they don’t reimburse you for these unclaimed benefits so these are essentially hundreds of dollars wasted never to be seen again.  

The best way to maximize your insurance benefits is to know exactly what they cover and their limitations. This article will go over the basics of understanding your policy and some tips and tricks of potentially getting a little bit more out of your vision plan. 

Know your coverage and frequency rates

First thing is to contact your vision care provider and ask what you’re covered for and the parameters for your coverage. Information like copays, allowance, lens enhancements and the total amount covered are important to know so you’re aware of any limitations to your plan. 

Not all vision care plans are similar and can have varying rates or features. For the most part, they will cover an eye exam and a pair of glasses (frames and lenses). Rates of coverage can vary from plan to plan. Below are key points to consider to get the most out of your insurance plan.

Things to consider:

Copay

A fixed amount that you pay regardless of what the optical retailer charges you.

Allowance:

The vision care for your insurance plan will pay a percentage of your glasses up to a specified amount.

For example, your plan could cover 80% up to $250.00 of your eyeglasses. This means your vision care plan will pay for 80% of the cost of your glasses up to a maximum of $250. You will be responsible for the difference in coverage either 20% of the cost or anything over $250. 

Example 1: Plan covers 80% up to $250.00 and the total cost of the glasses is less than or equal to the $250 threshold

Cost For Glasses	Allowance (80%)	You Pay (20%)
$250	$200	$50

The vision plan will only cover 80% of the $250 since it is less than the maximum coverage alotted

Example 2: Plan covers 80% up to $250.00 and the total cost of the glasses is greater than the $250 threshold

Cost For Glasses	Allowance (max)	You Pay (balance)
$350	$250	$100

The vision plan will use the maximum coverage alloted for $250 since the cost is above the maximum coverage threshold

Lens Enhancements

lens upgrades like photochromic/transition lenses, high index lenses, anti-glare coating, etc. are considered electives and may not be covered by your plan or have a separate allowance. 

Contact Lenses Exams and Contact Lenses

Contact lens exams and contact lenses are also classified as electives. Coverage rates may change or for some plans, they may not even be covered at all. 

Dates of Renewal

It’s also a good thing to know when the renewal dates are for your vision coverage. Insurance claims are based on the date of service regardless of when you receive your eyewear or if there have been any changes to your prescription. 

This means that if your coverage renews every two years (like most plans), and you purchase glasses with your coverage on December 31, 2019; you won’t be able to submit a claim until December 31, 2021. 

Sunglasses

Most plans will cover prescription sunglasses, but only some will allow you to claim non-prescription sunglasses. This may come in handy if you don’t need glasses or your existing pair does not need to be replaced. 

Your plan can also have a separate Health Spending Account (HSA) or Flex Spending Account for coverage on a broad range of medical products and that could include non-prescription sunglasses. 

Look into preferred optical retailer rates

Insurance providers can have partnerships or agreements with specific optical retailers and optometry practices. These preferred retailers, or in-network providers, can have special promotions or discounts exclusive to people under your benefits plan. 

Find out if there are any in-network providers and simply ask the retailer what the terms of the discounts are. They can assist you with all of the details associated with preferred rates and promotions. This can help you be aware of added discounts for your eyewear and get the most out of your vision care benefit plan.

Typically these discounts and promotions are constant. They will be available to you regardless if you’re making a claim or not. This may be useful for making eyewear purchases before your coverage has renewed. 

Don’t forget about Health/Flex Spending Accounts

There are a number of insurance plans that include a Health Spending Account (HSA) or Flex Spending Account (FSA) along with vision care benefits. These accounts can be used for any products or services outlined by the Health Spending Account. 

It’s good to be aware of what is eligible to claim under these accounts as they can be quite comprehensive. Some will allow you to bill for gym memberships or even sporting goods. 

Most importantly you can use these accounts to cover your eyewear expenses. If you’re under an allowance based program you can bill the difference that you paid for complete coverage on your purchase. 

Some plans may even let you claim non-prescription sunglasses under the HSA. These accounts expire and will renew after a given period. This means you can potentially take advantage of any remaining balance of your HSA to purchase a pair of non-prescription sunglasses or another pair of prescription eyewear. 

Take advantage of extra promotions

[Source: https://www.opsm.com.au/special-offers/50-percent-off-second-pair]

Optical retailers often have discounts for purchasing a second pair of glasses. If you wear glasses on a daily basis this could be a good time to purchase a set of prescription sunglasses or a second pair of eyeglasses. 

Typically optical retailers will offer at least 20% off on the second pair you purchase. Careful planning can make purchasing two pairs of glasses quite affordable. It could also maximize the number of glasses you can get depending on your insurance coverage. 

Use It or Lose It

You may be wondering why you would go through the hassle of using all of your benefits if it’s not needed. This rationale could be considered as ‘only using what you need’ but simply put you’ve already paid for these benefits. 

Get the most out of your insurance benefits and actually use them. Book your annual eye exam and get a new pair of glasses when your coverage renews. Routine eye exams are a great way to monitor the health of your eyes, and a new pair of glasses can be an excellent fashion accessory.