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Q&A: Stable networks are key to successful vision plan


In an interview with Business Insurance Associate Editor Gloria Gonzalez, Mark Hennen, a St. Paul, Minn.-based optometrist and chairman of the Eye Care Benefits Center for the St. Louis-based American Optometric Assn., discussed the key issues in vision care benefits and what employers should know about the connection between vision care and the overall health of their employees.

Q: What are the key issues in the vision arena?

A. The key issues in the vision arena, if you're looking to purchase vision care, would be the stability of the networks, the transparency of the benefit and what kind of discounts are you getting. Some health plans...their networks can change members from year to year so you want the find the network where the provider list in there is not changing and hopping around.

Sometimes some plans have riders written into them that they can change benefits, at their discretion, to the enrollee, to the payer or even to the doctor.

Q: So what should employers be doing in response?

A. They should make sure that the payers can show them the stability of the network--that their providers have been in this network for quite an extended period of time and will remain in the network and are happy with the network. They should also make sure that when they are looking at their contract that it's clear who's paying what, and that the plan does not have the opportunity or the option of changing things as they feel that they want to change them.

Q: Are there any innovative vision plan designs that employers are using or should consider using?

A. Most of the innovative stuff that you see out there has to do with diabetes. Diabetes and the diabetic complications of eye care and eye (care) delivery are sometimes listed as a separate rider, or they have the enhanced coverage for that service to make sure that people with diabetes are being seen when they're supposed to be seen.

Q: What should employers know about the connection between vision care and the diagnosis of serious medical conditions such as diabetes?

A. They should be aware to make sure that there is some kind of language in (their vision care policies) for collaboration with the primary care physician. Eye care providers...for diabetes, hypertension and high cholesterol, even can be the first people to find the disease process, so there has to be collaboration with the primary care physician to make sure these issues are addressed.

Q: One of the things we're hearing of is employers moving toward offering vision care as a voluntary benefit. What impact would this have on employees and maintaining their vision health?

A. When employers take the vision care benefit away, a lot of companies we're seeing are offering the plan back to their employee on a volunteer basis, which means the employee has to pay for that. With rising medical costs, employees also are paying higher premiums than they when employers remove a vision benefit plan that was in place, employees perceive it as a takeaway.

There was a plan in California that measured the incidence of newly diagnosed diabetics from their routine eye exam, meaning that people that came in for their routine eye exam didn't know they had diabetes.

And when they found out they had it, it saved the whole health care system money because the sooner you get on that, the better. It then saved the employer money because then you have less down time from the employee.

Even from a vision standpoint, if you find out they have cataracts, you can get those problems addressed earlier so that their acuities stay better (and) they're more productive employees.