Vision Insurance 102: A Glossary of Terms

Posted on December 27, 2023 in Vision Health

In our blog post, Vision Insurance 101: the Five Ws of your Vision Benefits, we shared the reasons why vision insurance is important and who should have it. Now, let’s take this a step further as we explain some of the common phrases used in vision insurance materials. Knowing these words will help you make better choices about your eyes and the care they need.

Understanding the Network

You may have come across provider networks when learning about health or dental insurance. Well, vision insurance has them too! Think of this network as a special club that vision specialists can join. As an “in-network” provider, they are able to offer you better pricing because of their agreement with your insurance plan.

Of course, you can always be seen by someone “out-of-network,” but in most cases you will have to pay more for services.

Find an in-network provider for DeltaVision Insurance here.

Allowance

Glasses come in different shapes, sizes and brands. There are also a wide range of colors and prices. To help lower the cost of frames when you purchase glasses, your vision insurance may offer a “frame allowance.” This is the amount of money that is available in your insurance plan to help you pay for new glasses. If you choose more expensive frames, then you may receive a discount on the cost above the allowed amount.

For example, let’s say you choose frames that cost $200, but your vision insurance only provides an allowance of $100 toward frames. To purchase these frames, you would have to pay the remaining $100 out-of-pocket. If your insurance plan pays 50% of the cost after the initial $100 allowance, then you’d only have to pay $50 for your new frames.

If your vision plan offers a frame allowance, be sure to shop for frames that fall within your budget.

Monthly Premiums

As with other types of health insurance, you should expect to pay a monthly premium for vision insurance. The “premium” is like a subscription fee that you pay to the insurance company for having vision insurance throughout the year.

Copays and Coinsurance

“Copay” and “coinsurance” are terms we sometimes mix-up because they are very similar. These are both costs that you are responsible for paying out-of-pocket when you see a vision specialist.

Copays are typically collected at the time of service, but can be billed later depending on the provider. These are pre-planned expenses for the services you receive. An eye exam, for instance, may have a $10 copay just for seeing the specialist.

Coinsurance is the percentage of cost that you are responsible for paying — the insurance plan pays the rest. For example, if you purchase contact lenses you might pay 60% of the cost for contacts, while your plan pays the other 40%.

Feel Confident Choosing a Vision Plan

Now that you’ve “learned the lingo” when it comes to vision insurance, you can choose the plan that’s right for you at your next annual enrollment period.

Do you have questions about the DeltaVision plans? Don’t hesitate to reach out to one of our specialists for more information.