The Survey Says: New Insights into Vision Care Benefits

Vision care is a critical aspect of health care that has been largely overlooked by insurers, advisors and plan sponsors. At the November 12th, 2024, CAO webinar, Dr. Langis Michaud, Optometrist and Professor, School of Optometry at the University of Montreal shared the positive long-term impact of prevention on vision health, particularly for children at risk of myopia. He also gave his support for vision care plans to include adequate coverage for the early detection and management of diseases like myopia to avoid the long-term costs associated with vision loss.

The Survey Results

The survey was designed to assess the awareness of vision care needs, satisfaction with existing benefits, and the willingness to make changes to deliver better health outcomes. The survey was conducted between July and August of 2024. A total of 77 respondents participated, including 16 insurers, 47 advisors, and 14 plan sponsors.

Key Findings

There is a significant gap in the vision benefits that insurers offer, and the desire for more comprehensive coverage under vision care benefits by all stakeholdes. Comprehensive coverage would give an allowance for diagnostic imaging and testing particularly, as well as for eye exams that include them, and recall examinations for those that need them.

What Insurers Say

Insurers are willing to consider further changes to vision care benefits, but the changes they made in the last three years have been focused on increasing maximums for frames and lenses as well as eye exams, not diagnostic tests and imaging, or adding a recall exam allowance, where change is needed.

Almost 60% of insures have reviewed or updated their vision plans within the last three years, mostly for frames and lenses and eye exams

Less than 10% of insurers have added an allowance for partial/recall exams, or diagnostic imaging and testing.

What Advisors Say

Advisors support further qualitative changes in vision care benefits, particularly in diagnostic imaging and testing. Limited by their options, advisors report that recent changes in clients vision care plans have focussed on increasing maximums for frames and lenses as well as eye exams. While this is positive, it still falls within the old thinking of what vision care is and which needs to be modernized.

75% discussed updating or reviewing vision benefits with clients in the last three years.

90% support the addition of new benefits or an increase in coverage limits.

What Plan Sponsors Say

Plan sponsors are open for changes to vision care, and most are not completely satisfied with their current plan. Their motivation for change in vision care benefits is largely based on addressing employee satisfaction and employee requests for change, but some are looking for a better understanding of the importance of vision care benefits.

Almost 65% believe further changes in vision care benefits offered by insurers is needed.

Over 55% of plans have not been updated or reviewed in four years or more.

The Growing Importance of Vision Care

The CAO is often asked why vision care is important now, and why plans should be changed? The answer is in part due to the alarming rise in myopia and other chronic illnesses such as diabetes, obesity and hypertension, and the resulting increased risk of vision diseases. Vision care plans can be used to address these effectively and reduce the risk of preventable blindness at a reasonable cost.

Myopia and Preventable Blindness

Myopia results in blurred vision at a distance and according to Dr. Michaud, is a factor in preventable blindness. High, unchecked, rates of myopia, such as -5.00 to -7.00 can result in a 3.3 times risk of glaucoma, 5.5 times risk of cataract, 21.5 times risk of retinal detachment, and 40.6 times risk of myopic maculopathy. The most common causes of vision loss include glaucoma. Early detection can prevent over 90% of vision loss in Canada.

The natural course of myopia can be changed by changing children’s behaviour, including less screen time and more time outdoors, and receiving regular ocular exams and follow-ups as necessary, including the use of anti-myopia devices to mitigate the impact of myopia.

Worldwide rates of myopia are increasing, and myopia is now recognized internally as a disease. Myopia rates in North America are expected to rise from 42% in 2020 to 58% by 2050, 56% in Europe and 65% in East Asia.

Addressing the Growing Need and Demand for Better Care

The survey results demonstrate that there is both a need and desire to improve vision care benefits. There are three critical areas of change in vision care that will help detect and reduce the impact of myopia and other vision diseases:

Increase comprehensive exam allowances.
Add recall exams within 24 months for those that need it.
Include an allowance for coverage of diagnostic tools and imaging.

With a long list of other priorities on the list of insurers and with technologies that are often out of date, changing vision care benefits is not a small ask, but it is a necessary one.

The CAO urges advisors and plan sponsors to call out insurers and demand a change in outdated vision care benefits by offering plan options. Medavie has already made changes to their vision care options and the CAO applauds them for their diligence.

For more details on survey results or to have a discussion with CAO on how to improve vision care benefits to meet clinical guidelines, contact info@opto.ca or denisebalch@connexhc.com or explore the www.dontlosesight.ca. site.

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