Many general health conditions are first detected through an eye exam — and many serious eye conditions don’t have obvious symptoms. From infancy to grade school, throughout your working life and into retirement, eye exams not only ensure the quality of your vision and your eye health, but the quality of your life.
But did you know that in Canada, general public health insurance only covers medical payments for eye injury and various eye diseases such as cataracts, glaucoma, and diabetic retinopathy?
What if you don’t have one of those conditions or are under the age of 65? Chances are it means you need to pay out of pocket for eye examinations, contact lenses, eyeglasses and/or frames, and, in some instances, part of the costs for elective laser surgery for vision correction – and facing those costs can mean you are tempted to put off getting your eyes checked.
Health insurance can help you eliminate poor vision
The good news for your finances is that most health insurance plans include a vision care benefit that can significantly reduce the cost of your prescription glasses, sunglasses, or contact lenses – it may even cover your entire order. In most cases, you can also use your vision benefits to pay for a comprehensive eye exam (OHIP provides annual coverage for children (0-19 years) and seniors (65 and above)).
Check your health insurance benefits before you shop, so you know which products are eligible and what you’re covered for. Typically, your plan will cover from $50 to $90 for your examinations, and from $150 to $300 for your glasses every 2 years.
You can choose to buy online to make the most of your vision benefits
Eyewear can be much more expensive than the amount your health insurance covers, but to solve that hurdle, buying glasses online is a growing trend. There are pros and cons to this approach, but the number one reason people choose online glasses are that they are much more affordable.
The cost of online glasses depends on the frames and lenses you choose to buy. Often, people are concerned about the accuracy of the prescription lenses they will receive – but some recent findings are that 90% of the time they are ok. These findings also note that bifocal and progressive lenses online are very difficult to buy – its best to get those at the optometrist’s office or with a store-front optician you visit.
The biggest difference between online shopping for glasses and going to your optician is the purchasing experience. Online stores offer many different glasses options – it can be overwhelming. In-store you have the positive advantage of trying the glasses on, so you can judge how stylish and comfortable they are.
To order online you need a valid prescription
You can get a valid prescription for eyewear when you get an eye exam from any licensed eye care professional. Your vision care benefit will likely pay for a part of any examination costs you incur.
To order glasses online, your prescription must be deemed valid:
- your prescription must have been administered by a licensed eye care professional within the last 24 months (if it’s a glasses prescription)
- or the last 12 months (if it’s a contact lens prescription) or be otherwise noted as ‘non-expired’.
The information on the prescription must also match the details entered into the claim, including the patient’s information and the parameters of the order.
Yes, you can use direct billing for eyewear
Direct billing is a quick and easy way to claim your health insurance benefits and avoid paying the full purchase amount upfront. Many online eyewear stores will accept your insurance information to process your insurance claim before the full payment is taken out of your account. That way, you don’t wait around to be reimbursed – with direct billing, you only pay for whatever is left over after your insurance has been applied.
You can also process a manual claim – once your eyewear has shipped out, you will receive an email with your receipt, which you can use to file a claim with your provider.
Make sure you have health insurance and vision benefits today
Getting regular eye check-ups plays an essential role in ensuring good health for you and your family — and health insurance helps cover the costs of vision care! At SBIS, we specialize in helping you make the best possible decisions on what health insurance plan will work the best for your needs. We’re ready to answer your questions. Just give us a call at 1-800-667-0429 Monday to Friday, 8:45 a.m. to 4:45 p.m. ET for your health insurance options today.