Seeing Vision Care Differently

by | Mar 17, 2021 | Employee Benefits, Group Benefits, Take 5 Articles

Every year, employers are challenged to allocate available funds among all their benefit plans. While drug plans are always in the spotlight, other benefits like vision care are also very important.

Unmet needs for eye health

Almost six in 10 Canadians (57%) report impaired vision, according to The Business Case for Better Workplace Vision Care Benefits, a report available from your advisor as a member of The Benefits Alliance Group. Among those aged 45 to 54, 2.7% had impaired vision even when they wore corrective lenses, rising to 5% for those aged 55 to 64. An aging population also carries increasing risk of serious vision loss or even blindness caused by conditions such as age-related macular degeneration, diabetic retinopathy, glaucoma or cataracts. All of these can be detected by a comprehensive eye examination.

Vision care benefits

About seven in 10 employers (71%) offered vision plans in 2018, according to the annual Sanofi Canada Healthcare Survey. In 2016, that same survey reported that 91% of employees highly valued vision plans, but 21% said their plan was poor or very poor. This was the highest level of dissatisfaction among all benefit types.

This concern may be related to high personal costs for eye health. Most vision plans provide much less than the amount needed for eye exams and corrective lenses. Plan members with greater needs are particularly disadvantaged. Provincial governments provide very limited coverage for their working-age citizens. Consequently, 67% of vision care costs in 2018 ($3.6 billion) were paid out-of-pocket, a percentage far higher than for drugs (20%) or dental (39%). Given the importance of eye health, some rebalancing may be needed.

The advisor survey

We wondered why vision care benefits were not keeping pace with costs and needs, or with improvements made to other health benefits. In September 2020, Benefits Alliance surveyed its member firms. The survey was sponsored by the British Columbia Doctors of Optometry and Alcon Canada. Twenty-five advisors responded, representing about 1,700 mostly small and mid-sized employers that offer vision plans.

Several interesting findings emerged, including:

  • The two most common biennial maximums were $200 and $250. Most plans had limits below $300.
    Implication: Since the cost of a comprehensive eye exam varies between $100 and $200, according to the Canadian Association of Optometrists, this maximum leaves very limited support for the cost of corrective lenses, diagnostics or treatment.
  • Advisors reported about three-quarters (76%) of their clients were likely to maintain their vision benefits over the next two to three years.
    Implication: While this is good, especially after a year of pandemic disruption, few vision plans are being modernized and coverage quality will fall further behind other benefits.

Advisors also evaluated a number of statements about vision care benefits. Two stand out, both speaking to the need to review and modernize vision plans:

  • 81% agreed (42% strongly) that it is reasonable for employers to cover the cost of an eye examination at the same level of reimbursement used for other extended health benefits, e.g., 80% or 100%.
  • 80% agreed (32% strongly) that an eye examination by an optometrist is as valuable to plan members as a necessary visit to a physician, pharmacist or dentist.

For more information about how to modernize vision care plans, ask your advisor about The Business Case for Better Workplace Vision Care Benefits. You can also visit DON’T LOSE SIGHT, a website by the Canadian Association of Optometrists.

Drawing conclusions

Most Canadians have impaired vision and our aging workforce is at higher risk of serious but still manageable diseases of the eye. Loss of sight is as serious as any major health deficit, and an eye exam by an optometrist is as important as care provided by any other health professional. Yet, competing needs mean most vision plans have not kept pace with improvements made to other health benefits, or with scientific, clinical and technological advances in vision care.

Speak with your advisor to ensure your benefits plan provides appropriate preventive eye health care and reimbursement of corrective lenses.

Chris Bonnett is Principal Consultant at H3 Consulting, which assists organizations in developing workplace health strategy and provides health policy research and analysis, specializing in pharmaceuticals. CHRIS@HTHREE.CA. This article was supported by Alcon Canada and the British Columbia Doctors of Optometry.