Visual Acuity, Impairments and Vision Insurance Plan Provisions. Stuart West Specialty Sales Manager Virginia CE Forum 2009 Course #

Transcription

1 Visual Acuity, Impairments and Vision Insurance Plan Provisions Stuart West Specialty Sales Manager Virginia CE Forum 2009 Course #

2 How Vision Works Light passes through the cornea & lens Light hits retina containing 2 types of cells: Rods: low light vision Cones: color and detail Rods and cones react chemically Electrical impulses sent to optic nerve Brain processes the impulses into images 2

3 Visual Acuity 20/20 vision: you see at 20 feet what a person with normal vision should see at 20 feet 20/40 vision: you need to be 20 feet away to see what a person with normal vision sees at 40 feet 20/10 vision: what a person with normal vision sees at 10 feet, you can see at 20 feet 3

4 Visual Impairments Visual Impairment: 20/40 in better eye w/ corrective lenses Low Vision: 20/70 20/160 Legal Blindness: 20/200 or a visual field less than 20 degrees Total Blindness: no light perception 4

5 Visual Impairments Only 35% of Americans have 20/20 vision without corrective lenses or procedures 75% of Americans have 20/20 vision with corrective lenses or procedures 5

6 Common Vision Impairments Myopia Hyperopia Presbyopia Glaucoma Macular Degeneration Ametropia Anisometropia Keratoconus Cataracts 6

7 Common Vision Impairments Myopia: Unable to see distant objects clearly Near-Sighted Hyperopia: Unable to see close objects clearly Far-Sighted Astigmatism: Difficulty distinguishing contrast Defect in curvature of cornea Imprecise near and far vision Unclear contrast between lines 7

8 Common Vision Impairments Presbyopia: Age related Diminished ability to focus on near objects Linked to loss of elasticity in lens and loss of power or control in muscles that control lens 8

9 Common Vision Impairments Glaucoma: Group of diseases involving increased pressure in the eye which cause sight loss Cataracts: Clouding of the lens Leading cause of blindness 9

10 Common Vision Impairments Macular Degeneration: Loss of vision in center of vision field (macula) Usually older patients No cure, but treatments are advancing for wet macular degeneration to halt the progress of the disease 10

11 Common Vision Impairments Anisometropia: Eyes have different levels of acuity Differing degrees of myopia or hyperopia Rare occasions of myopia in one eye and hyperopia in the other Keratoconus: Elongation of the cornea 11

12 Corrective Procedures Eyeglasses Contact lenses Eye surgery 12

13 Vision Insurance Plan Provisions Eye exams Lenses Frames Corrective vision surgery Discounts 13

14 Vision Insurance Plan Provisions Eye exams: Suggested annually or as advised by your eye-care professional Can diagnose: Visual impairments Eye diseases Diabetes High blood pressure Tumors 14

15 Eye Exam Questions about overall health & family medical history Visual acuity test (Snellen Chart) Ophthalmoscope looks into eyes Exam to view cornea (surface) Test eye movement & peripheral vision Lens testing w/ Snellen Chart Tests for glaucoma & color blindness 15

16 Eye Exam Coverage In Vision Plans Usually covered with a copayment May be offered as part of medical insurance coverage Usually covers standard eye exam Specialty or condition-related exam usually not covered under vision plans 16

17 Frames Materials designed for: Light weight Flexibility Hypo-allergenic Almost every fashion designer has a line Prices range from $15 $

18 Frame Coverage In Vision Plans Most plans give allowance toward frames, then offer discounts after the allowance Some plans use allowance, but limit to formulary of frames Some plans allow any frames with an allowance 18

19 Lenses Glass lenses rarely needed today CR39 is the industry term for the plastic lens material Polycarbonate lenses reduce weight 19

20 Lenses Lens Types: Single Bifocal Lined Progressive Trifocal Coatings/Add-ons: UV protection Tint Scratch resistance Anti-reflective (AR) Photochromic Lined Progressive 20

21 Lens Coverage In Vision Plans Standard lenses (no coatings or options) are covered under copay Optional coatings or lens types: Usually offered w/ additional copay Added copay for each option Some carriers add options at no additional copay 21

22 Contact Lenses Elective: patient prefers contacts to eyeglasses Non-elective: eye condition requires contacts instead of eyeglasses Extreme near/far sightedness Extremely different prescriptions in each eye Keratoconus 22

23 Contact Lenses Types of lenses: Hard Soft (daily, weekly monthly) Rigid Gas Permeable Vial (remove nightly, last up to one year) Toric (for astigmatism) Bifocal 23

24 Contact Lens Coverage in Vision Plans Usually covered with copayment Can be same, less, or more than traditional lens copay (usually the same) Contact lens fitting covered by some plans 24

25 Contact Lens Coverage in Vision Plans Standard fitting: 80% of fittings 1-2 follow-up visits are standard Can be covered a part of contact lens copay Can be: Additional copay Discount No coverage 25

26 Contact Lens Coverage in Vision Plans Premium fitting: 20% of fittings 3-4 follow-up visits are standard Can be covered a part of contact lens copay Can be: Additional copay Discount No coverage 26

27 Laser Vision Surgery Excimer Laser surgery started in 1987 Lasik approved by FDA in 1996 Traditional, Custom, Bladeless Myopia, Hyperopia, Astigmatism 27

28 Laser Vision Surgery Process Eye is numbed Small flap is cut in cornea Laser used to reshape cornea Flap is replaced 28

29 Laser Vision Surgery Coverage Network with negotiated price per eye Percentage discount 29

30 Vision Insurance Plan Provisions Discount Plans Network of vision providers Percentage discount on procedures or Set fees for procedures Most full-service vision plans also offer discounts beyond covered services Becoming popular as add-on benefit to medical and dental plans 30

31 Vision Insurance Plan Provisions Other exclusions & limitations: Lenses usually limited to one set per year under copay (discounts on additional lenses may be offered) Frame allowance usually limited to 12-month or 24-month period (discounts may be available on additional frames, but often require full set of eyeglasses) Some of the highest-end designers do not allow discounts on any of their frames, and may not be available under vision plans 31

32 Vision Care Providers Ophthalmologist: Medical doctor At least three years residency in ophthalmology Prevention, diagnosis, medical and surgical treatment of eye conditions and diseases 32

33 Vision Care Providers Optometrist: Health care professional licensed to provide primary eye care Four years in college of optometry Examine and diagnose eye diseases Diagnose related diseases that may effect eyes Examine, diagnose and treat visual conditions Prescribe glasses, contacts, low vision rehab, eye medication Perform minor eye surgery such as removal of foreign bodies Optician: Health care practitioner who provides lenses for the correction of refractive errors 33

34 Eye Care Provider Locations Private practice (Ophthalmologists and Optometrists) Retail Locations (LensCrafters, Pearle, Target, For Eyes, Costco) Internet 34

35 Questions? 35