Can I Use 2 Vision Insurance Plans? A Guide to Coordinating Vision Benefits

Having vision insurance can provide great savings on eye exams, glasses, and contact lenses. But what if you’re covered under two separate vision plans? Is it possible to use both vision insurance plans to maximize your eyecare benefits?

The answer is yes! With proper coordination, you can often combine two vision insurance plans to get more comprehensive coverage. This article provides a complete guide on how to coordinate dual vision benefits.

Overview of Coordinating Dual Vision Coverage

Coordinating two vision plans involves designating one plan as your primary coverage and the other as secondary. Here’s a quick rundown of how it works:

• Your primary vision plan is used first to cover costs of services and products up to its benefit allowances. You are responsible for any copays or costs above the primary plan’s benefits.

• Next, your secondary vision plan can be used to cover any remaining out-of-pocket costs after the primary plan’s benefits have been applied.

• Together, your primary and secondary plans provide combined coverage that can significantly reduce your overall eyecare expenses.

• To coordinate benefits, you must inform your eye doctor that you have dual coverage and provide details on both vision plans. Proper coordination requires submitting claims in the correct order.

The key advantage is that you can access a higher total benefit value by combining both plans. But it does require some extra effort to coordinate properly.

When Can You Use 2 Vision Plans?

The most common situation where two vision plans come into play is when both you and your spouse have coverage through separate employers.

Other scenarios where you might have dual vision benefits:

• A parent and spouse who both have vision insurance.

• College students who are covered under their parents’ plan and also have school-sponsored coverage.

• Retirees who have a private vision plan and also qualify for vision benefits through Medicare Advantage or Medicaid programs.

• Employees who have vision insurance from their job as well as coverage through a separate individual or family vision plan purchased privately.

As long as you are eligible to receive benefits under both vision plans, you can coordinate the plans to maximize your overall coverage.

How Does Coordination of Vision Benefits Work?

When you have two vision plans, one insurer serves as the primary payer while the other is secondary. Here are details on how payment coordination works:

Designating a Primary Vision Insurer

• The primary vision plan is responsible for paying covered benefits first, up to its maximum allowances.

• Typically, the vision plan that covers you as the primary subscriber is considered primary. For example, if you get vision benefits through your employer, then your plan would be primary.

• If covered under two plans as a dependent, then the plan you’ve had for a longer period is usually primary. Coordination rules differ between insurers though.

Role of the Secondary Vision Insurer

• After the primary insurer pays benefits, the secondary plan can cover all or part of your remaining out-of-pocket costs.

• The secondary plan analyzes the primary plan’s benefits payments and pays additional benefits based on its own coverage terms.

• There is coordination between the two plans so benefits are not paid twice for the same products/services.

Submitting Claims Properly

• To coordinate benefits correctly, claims must first be submitted to your primary vision plan.

• After the primary plan has processed the claim, the claim can then be submitted to your secondary insurer along with the statement from the primary carrier.

• Vision providers will handle this claims submission sequence for you if they are aware of your dual coverage.

Getting the Most from Combined Benefits

• To maximize benefits, the covered services you receive should align with the benefits offered through both plans.

• Understand each plan’s coverage terms so you can take advantage of all benefits available through coordination.

• Work with your eye doctor to determine the optimal timeline for using both benefit plans. You may need to split services across two plan years to maximize coverage.

Dual Coverage Coordination Example

Here is an example of how an individual might use coordinated vision benefits:

• Juan’s Primary Vision Plan: $150 allowance for frames or contacts. Standard lenses or coatings have fixed copays.

• Juan’s Secondary Vision Plan: $120 frame allowance. $120 contact lens allowance. Helps cover cost of coatings and upgrades.

• Juan’s Eyecare Costs: Designer frame chosen that costs $220. Custom coated lenses for $150. Contact lens exam and fittings for $90.

• Claims Processing:

  • Primary plan applies $150 toward frames, reducing cost to Juan to $70

  • Secondary plan applies $120 to further reduce frame out-of-pocket to $0

  • Primary plan pays fixed lens copays per its policy.

  • Secondary plan reduces Juan’s coatings cost to $0.

  • Exam and contact lens fitting costs covered under primary, with $0 out-of-pocket after coordination.

Total Juan Pays: $0

This example shows how Juan was able to get his complete eyecare needs covered at no cost by combining his two vision plans.

How to Coordinate Your Dual Vision Coverage

Follow these key steps to properly coordinate your vision benefits:

Inform your eye doctor – Let your eye doctor know you have two applicable vision plans and provide details on both policies. Your provider will need this information to submit claims accurately.

Designate a primary insurer – At the outset, you’ll need to indicate which vision plan serves as the primary carrier. In most cases this is dictated by coordination rules.

Check plan details – Review both vision plans’ coverage terms so you understand available benefits. Look for differences in plan years, networks, and benefit frequencies.

Maximize benefits – Discuss optimizing benefits across both plans with your eye doctor. You may need to strategically split services across two plan cycles.

Submit claims in order – The initial claim must go through your primary plan first. Only after that should your provider submit the second claim to the secondary insurer.

Confirm payments – Follow up to ensure both plans remitted payments as expected so there are no surprise out-of-pocket costs.

With this process, you can effectively use both vision plans to reduce your expenses and get the most from your coverage.

Vision Insurance Coordination Rules

While the coordination process outlined above may seem straightforward, the specifics of how insurers will coordinate benefits can be complicated. Here are some notable rules that come into play:

• Insurer determination rules – Each insurer has rules dictating which plan pays primary vs secondary when the insured has dual coverage.

• Non-duplication of benefits – Vision plans avoid paying benefits for the same services twice through coordination.

• Benefit determination rules – Specific rules indicate how primary and secondary plans pay out benefits and determine allowances.

• Policy provisions – Individual policy terms impact coordination rules (such as “carve-out” provisions).

It’s in your best interest to contact both insurers directly to obtain details on their specific coordination procedures when you are covered under two plans.

Challenges of Coordinating Vision Insurance

While using dual vision coverage can maximize benefits, there are some potential drawbacks and challenges to factor in:

• Administrative complexity – Coordinating coverage requires effort and diligent tracking to ensure accurate claims submission.

• Claim delays – Having multiple payers involved slows payment timeframes, in some cases significantly.

• Rule confusion – Given varied insurer rules, it’s hard for providers and patients to fully understand payment ordering.

• Provider network issues – Differences in plan networks and provider access creates additional coordination complexity.

• Benefit imbalances – Secondary plans often have less rich benefits, limiting the upside of coordination.

• Plan instability – Job changes or shifting family status adds volatility when coordinating across multiple vision plans.

Key Considerations When Using Dual Vision Coverage

If you decide to coordinate dual vision benefits, keep the following important tips in mind:

• Check if your providers accept both vision plans to avoid network restrictions.

• Try to align open enrollment periods so plans renew at the same time if possible.

• Avoid benefit gaps between plans that reduce combined coverage.

• Set up coordination at the start of a plan year to maximize savings.

• Confirm specific insurer rules to prevent claims issues.

• Get benefit details on both plans in writing.

• Follow up on claims to check payment accuracy.

Professional Guidance Can Help Optimize Coordination

Given the complexities of coordinating dual vision coverage, working with an eyecare professional that deeply understands vision plan provisions is key.

Vision insurance experts can guide you in optimizing your combined benefits potential. Seek out providers that proactively maximize insurance savings for patients with multiple vision plans.

Is Coordinating Vision Plans Worth the Effort?

Coordinating two vision insurance plans requires some extra work, both for patients and vision providers. But the payoff can be maximized coverage that