Although millions of Americans use some form of correctivelenses to see, when employers break out their vision plans as anancillary benefit, the rates at which employees sign up for and usethe plans drops dramatically.

For example, in 2008, the Bureau of Labor Statistics reported 42percent of employees at large employers took advantage of ancillarydental plans, but only 16 percent participated in ancillary visionplans.

This is at least partially because many companies don't offerstand-alone vision plans at the same rate they offer dental ones;that same study showed 50 percent of large employers offered astand-alone dental plan vs. 19 percent that offered vision plans.Clearly, many employers don't see the value in offering stand-alonevision coverage for employees, and it's increasingly rare to findan overall health plan that also covers vision.

But despite the perception that vision coverage isn't worth theeffort it takes to find and secure a plan for employers— and, as aresult, vision might not be seen as worth the investment forbrokers who offer assorted ancillary health plans—there arecompelling reasons why employers might want to consider providingvision-plan options for employees, and why brokers might want tolisten.

Greg Rudisill, senior vice president of strategic partnershipsat Careington, who's worked with Careington's employee benefitsprograms for more than three decades, says he can see both sides ofthe argument.

“Originally, back in the '70s, '80s and throughout the mid-'90s,the preponderance of vision plans that were offered wereemployer-paid,” he explains. “So you had almost the entire employeeand dependent population with access to the vision program. Theemployee wasn't paying for it, and the costs were very low, so itwasn't a dollar swap.

“What started happening around the late '90s is that employerdollars started getting used up because of increasing medicalcosts, so instead of continuing to offer vision as a benefit forall employees, employers started shifting the cost of dental andvision insurance—ancillary costs—to employees,” Rudisill continues.“And then you get voluntary selection, where only the employees whoknow they're going to use the full amount available will sign upfor the plan.”

However, Rudisill notes, there are good reasons why employerswould want to encourage staff to participate in an annual visionexam.

“With a vision exam, the doctor can catch all kinds of medicalmaladies during the course of that exam,” he notes. “Cancerproblems, diabetic conditions—they can save a person's eyesight andlife and get them in to get treated more quickly so medical costsfor some of those serious conditions aren't as expensive.

Windows to good health

David Noel, vice president of sales for Workforce Tactix, saysthat vision insurance provision has been evolving for years, andthat by examining what some of the largest businesses in thecountry are doing—from Safeway to Walgreens to UPS—brokers andemployers can see where vision plans are heading.

“One of the things we've seen with large companies is thatthey're putting stock in vision insurance,” Noel says. “The eye isthe single internal organ that presents itself at the surface. Wecan look at the eye and diagnose medical conditions without havingto draw blood. And the large companies, which are typicallyself-funded, realize that if they can diagnose some of these thingsearly on, it has a significant financial savings as the conditiongrows. Cancer is easier to treat in stage I than in stage IV.Vision plays a huge part in that.”

Joseph Torella, employee benefits national practice leader andpresident of the northeast employee benefits division of HUBInternational, agrees—but he notes that the ability to link an eyeexam with follow-up care is important, too.

“When you look at oral and ocular health, you're looking forpotential early indicators,” he says. “The goal, long-term, wouldbe to have a carrier who can link the different levels together. Ifyou see something in the eye exam, are you connecting it to otherclinical indicators? All of these scenarios strongly suggest that agood population health program will connect the different areaswhere people will get their exams.

“If I'm looking at myself as a plan sponsor and what I should bedoing for my employees, I think every company should be lookingclosely at biometrics and the early indicators of disease thatmight not manifest as a clinical read,” he continues. “The minuteyou see that your glucose level has deteriorated, you probably havesome issues in the retina. If you have heart disease and diabetestogether, and you're classified as obese, then you've got some realpotential for damage.”

And although population health isn't something an employeesigning up for a plan would likely consider, an employer benefitsfrom offering strong vision and disease-management programs,Torella notes.

A question of choice

Employee education—and an employers' understanding of what aparticular employee population wants and needs in terms ofcoverage—is another facet of the vision question. Chris Costello,principal and founder of CBG Benefits, helps employers deploysurveys that help them ascertain what products staff would like tosee offered, from pet insurance to vision.

“We're big proponents of choice in the workplace,” Costellosays. “You might get folks who say, 'Only a third or half of mygroup really needs vision coverage,' but you can't really start tosplit hairs—because maybe you don't wear glasses, but your husbandor your kids might. People have to keep things in perspective andmaybe offer plans that aren't going to provide you with Armaniglasses but will provide you with the basics.”

Torella says that in many cases, HSAs can take the place of adedicated vision plan, while allowing employees who don't need avision benefit to use those funds for other medical costs.

“The idea of a company being paternalistic and giving allbenefits to all people is a wonderful concept when you can affordit,” he says. “Over time, we've gone to a more consumer-drivenmodel—you'll make different choices if you have a family with threechildren and all three of them need glasses. As an employer, do youreally want to make the decision of what's important to youremployees, or do you want to give them a budget and give them theresponsibility to determine where that dollar amount goes? Thosedecisions are exactly why we have HSAs, which allow people tobecome more accountable.”

But the growing proliferation of HSAs and flexible-spendingaccounts also might contribute to declining employee enrollment invision plans.

“Typically, an individual member consumer will put pen to paperto decide whether it makes sense to buy a voluntary vision plan,”Rudisill says, “and if they don't feel there's enough value, thenthey won't enroll in the plan. They might instead put their moneyin their FSA or HSA and use those tax-advantage savings to gettheir ancillary services, like vision.”

The discount route

Rudisill also mentions the possibilities of employer-fundeddiscount plans, which offer steep discounts to employees for eyeexams and vision products, including contact lenses andglasses.

“It's extremely low cost compared to insurance plans, and itoffers savings that range anywhere from 20 percent to more than 50percent,” he notes. “We encourage the use of FSAs or HSAs incombination with our vision discount product. So the member getsthe savings from a tax perspective by setting aside the moneypre-tax, and then they go into the network of providers we offer,and they can save an additional percentage on their vision careneeds. We believe that's a better alternative than offering avoluntary insurance plan, and people are very happy with thediscount products.”

Rudisill explains the provider networks for discount programstypically are much larger than for an insurance plan—oftenincluding large retailers such as Target and JC Penney—andemployees can see exactly what a given service or product will costand what the discount will be before booking an appointment.

“If they know what it's going to cost them in advance, they canset aside that specific amount of money in their FSA account, andit's also a benefit because it's a program that's very easy toimplement and use,” he says. “And providers love it because theydon't have to do a lot of administrative work like with aninsurance plan—a typical vision discount plan might cost $1 or lessper month, whereas with an insurance plan, you're going to spend$20 to $25. And many times with a discount plan, they're solow-cost that the employer will pick up the access cost, so all theemployees have access, and they don't have to go through theenrollment process.”