Vision

How Vision Coverage Can Make a Difference in a Child’s Future
by Karen Gustin, LLIF, Ameritas Group

Abby’s world was fuzzy. At three, she ..was always busy playing with her totoys, but she often did not recognize the items her parents asked her to pick up or put away. Many things blurred together for her, but Abby’s parents didn’t recognize the problem. Abby probably assumed that this was how the world looked to everyone. During a routine eye examination, prompted by a back-to-school checkup for her older brother, the doctor discovered that Abby needed eyeglasses to correct her vision. Suddenly, Abby’s world became clear and those fuzzy objects took on new dimensions.

But at seven, Abby had problems reading and completing schoolwork. Her parents and teachers wondered about the cause; was it a learning issue or was she having more vision problems? Thanks to the eye care insurance benefits available through her employer, Abby’s mother didn’t hesitate to schedule a comprehensive eye exam. Through extensive testing, the doctor discovered that Abby’s eyes had convergence issues, which means that her eyes were not working together. Though she did not have trouble completing math problems, she could not read words across a page. For the next six months, Abby’s vision therapy consisted of weekly professional developmental sessions in the doctor’s office and short daily exercises at home to train her eyes to work together. A year later, Abby no longer struggled to read, pay attention in class, or complete her assignments.

Vision Problems Hamper Learning

More than 60% of problem learners have undiagnosed vision problems, according to the National Institutes of Health and the National Eye Institute. And one out of every 20 school-age children is affected by Abby’s condition – convergence insufficiency. Symptoms of vision problems include intermittent blurring, loss of concentration, regular headaches, consistent loss of place when reading, or diminished focusing power. These symptoms can become obstacles for kids who are trying to pay attention and learn in school.

Kids today spend a lot of time playing computer games or watching TV, which can lead to eyestrain, blurred vision, or headaches. In addition, children born prematurely with a low birth weight or whose mothers had specific types of medical concerns during pregnancy, may also have eye and vision problems as they grow and develop. In most cases, kids cannot report and recognize their vision problems because they have never had clear vision. Also, many kids don’t notice gradual vision changes.

Untreated eye and vision problems can affect a child’s performance in school and result in the misidentification of the root cause of learning issues. Eighty percent of what kids learn in the early years is visual, according to a 2008 report by the American Optometric Association (AOA). Kids need more than 15 visual skills to succeed in reading, learning, sports, and in life, according to the College of Optometrists in Vision Development.

Comprehensive Eye Evaluations are Important for Kids to be Successful

Nearly two-thirds of six-year olds entering school have not had their eyes checked by an eye doctor. Ten million kids suffer from vision disorders, which are among the most common disabilities in the United States, according to the National Parent Teacher Association. Many of these children have had simple vision screening tests, often passing with 20/20 vision. But, these tests only identify 5% of vision problems since they only indicate whether a person can read letters from 20 feet away. They cannot readily identify a person’s eye tracking skill or ability to focus their eyes over a short period of time. Eye screening tests are not considered effective in detecting eye or health problems.

Medical professionals recommend a comprehensive wellness eye examination as a critical component of disease management. During a comprehensive exam, a variety of tests provide valuable information to help doctors detect or rule out serious health concerns, such as cancer, arterial blockage, thyroid disease, diabetes, high blood pressure, high cholesterol, strokes, and multiple sclerosis. The AOA recommends that parents begin eye assessment checks for children during their first year of life, typically between six to 12 months.

Eye Care Insurance is Critical

Parents with no insurance to cover eye exams or inconsistent coverage are less likely to seek care regularly even if they or other -family members have a vision impairment, according to the National Eye Institute. Many employers are trimming employee benefit packages in today’s challenging economy. They’re requiring employees to pay more out-of-pocket for insurance coverage and making some plans, such as eye care insurance, a voluntary option. Parents, too, are feeling the financial crunch and they are delaying non-urgent health-related expenses.

Eye Care Plans Offer Choices

Comprehensive eye care insurance is a low-cost employee benefit. This option encourages employees to participate in a yearly comprehensive wellness exam and covers a portion of corrective vision costs. -Employers can offer eye care benefits at little or no cost or as a voluntary insurance option. These plans give employees access to quality eye care services at a discounted group rate, along with the convenience of payroll deduction and flexible spending -account coverage for the premium cost.

As with all insurance benefits, every plan is designed differently, with variable options and prices. Producers should review the features and coverage restrictions, along with the price, to ensure that the plan will match employers’ needs.

Provider Network or Not?

Eye care plans have typically featured a network of eye care providers. The appeal may be limited to larger markets where there are numerous eye care offices. Employers in smaller markets with fewer eye care doctors believe they have limited eye care insurance benefit options. Employers may think that having employees use their flexible spending account for eye care expenses is their only option. But that’s not the case.

Plan Option Without Restrictions

Some eye care carriers are now offering a “no-network” eye care benefit, giving employees in smaller markets access to insurance options similar to the larger network plans. With no network restrictions, employees can visit the eye care providers of their choice. Most of these plans are based on a schedule of benefits so employees know exactly what the plan will reimburse. Prices can be very affordable for the voluntary market and employers get a solution that fits everyone’s needs.

Evaluate Plans and Carriers

Eye care insurance is relatively simple in design and the premiums are typically one-tenth of a standard health plan. While many carriers offer eye care insurance plans, not all include coverage for comprehensive wellness examinations and services.
When comparing eye care carriers, evaluate their qualifications in these areas:
• Experience with eye care insurance.
• Quality eye care insurance coverage including coverage for comprehensive exams.
• Flexibility in plan design so modifications can be made easily to accommodate employee changes and growth.
• Quality and size of the eye care provider network. (Ask carriers how the doctors are evaluated to ensure they are credentialed and qualified to perform the services offered.)
• Relationship with network doctors.
• Reputation for customer service, quality care, and employee satisfaction.

Help Employers See the Benefits of Eye Care Plans

There are many eye care insurance plan options available today. Communicate the value of eye care insurance to employers and offer them a quality eye care insurance plan that includes a comprehensive wellness examination to protect their employees’ eyes and access complete eye care services for their children.

Work with a carrier that’s interested in partnering with employers to design eye care benefits that meet their needs. The carrier should have the flexibility to support employers’ changing needs, have network and non-network plan options, as well as quality customer service and administrative support. The right carrier can help ensure employers’ satisfaction with eye care insurance benefits and make your job a lot easier.
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Karen M. Gustin, LLIF, is senior vp of Group Marketing, Managed Care and National Accounts for Ameritas Group, a division of Ameritas Life Insurance Corp. (a UNIFI Company), with headquarters in Lincoln, Neb. A provider of dental and eye care products and services, Ameritas Group added hearing care to its product portfolio in 2008. Gustin joined Ameritas Group in 1983. She is vice chair of the National Association of Dental Plans’ board of directors and its statistical task force, and also serves on NADP’s executive committee.