Vision and Hearing Care Benefits Flashcards
Module 5
Vision care plans typically include what benefits?
Usually cover routine eye exams and certain ocular tests such as coordination or eye movements, tonometry, depth perception for children and refraction testing for distance and near vision. The plans also cover certain products such as lenses, standard type frames and contacts
Describe the vious approaches to vision care plan design
Plans use frequency limits on the number of times a participant can receive benefits such as lenses or exams. 12 or 24 months periods are common limits.
Vision plans may use ______, ______ networks, and/or flexible benefits approaches in designing a plan after frequency limits.
A. Schedule or benefits
B. Preferred provider
A schedule of benefit plan sets maximum dollar limits on the amount that will be paid toward specific benefit, say ____ for and exam and ___-___ for lenses depending on their complexity. The plan pays the lesser of the charged amount or maximum
A. $50
B. $60-$140
How are preferred provider networks for vision benefits similar to those for medical care.
In network care pay minimum copayment for services and discounted charges for products. There is sometimes coverage for services/products when a non-network provider is used, with reimbursement based on a schedule or usual, customary and reasonable (UCR) charge
Vision plan benefits can also be included in ____ _____ ____.
If not covered under a plan, a flexible spending account can be used to fund planned vision care expenses on a pretax basis.
Flexible benefit plan
Explain whether hearing care typically is covered by standard surgical and major medical policies
Surgical procedures affecting the ear are normally covered in standard medical policies and generally are included in HMO coverage. In addition, some HMOs major medical and comprehensive policies include hearing aids. However, more complete coverage is afforded by plans specifically designed to cover hearing care.
Describe the types of hearing care benefits typically included in separate hearing care benefit plans
Common package includes 80% reimbursement for services and materials up to a maximum of $300 and $600.
Frequency is usually every 36 months.
Describe the items that are often covered
- Otologic examinations (by physician or surgeon)
- Audiometric examinations (by an audiologist)
- Hearing instruments
Medical doctors specializing in total care of the eye, including diagnosis, treatment of eye diseases, and surgery. Many perform eye examinations and prescribe corrective lenses. Some also dispense corrective eyewear.
Ophthalmologists
Licensed to examine, diagnose, treat, and manage diseases and disorders of the visual system, the eye, and associated structures as well as diagnose related systemic conditions. Trained to detect eye disease and or symptoms requiring the attention of ophthalmologists.
Optometrists
Fit, adjust, and dispense eyewear prescribed by ophthalmologists and optometrists.
Opticians
