Wednesday, January 21, 2009

Attempting to Understand New Insurance Policy

On January 1, 2009 my primary employer changed insurance companies. At first glance, based on an employee meeting, the changes will be a good one for all involved. Some out of pocket expenses are a bit higher (ie. employee contribution, co-pays) but overall I believe this may be a better policy. Our insurance covers medical, dental, vision, and Rx drugs.

Currently I am trying to figure out our vision policy. I need two pair of eyeballs--everyday use and ANSI approved safety glasses. Al tho tinting has been suggested it is not required, but I do require bifocals. I plan on using an in-network provider which in our case is Wal*Mart (I'm not thrilled by this but through word of mouth I have discovered that our "local" Wal*Mart is very good.) Also by comparing prices I have determined that financially Wal*Mart has by far the best prices compared to our local independent store even without insurance; 2 pair can be had at a lower cost than purchasing just one pair locally. (As much as I would prefer to shop here in town, I just can't justify the added cost.)

But I digress. If I am reading my policy correctly the following will hold true:

  • $10 co-pay for eye exam
  • $10 co-pay for "materials" a single co-pay that applies to entire purchase of glasses (lenses & frames)
  • one pair lined bifocals covered in full
  • standard scratch resistant coating applied at no charge
  • $130 frame allowance
So for a $20 co-pay my everyday glasses are covered BUT what about my ANSI eyeballs?

My company offers a $70 PPE account (personal protective equipment). Since I purchase my steel-toed shoes at Wal*Mart I have been "saving" this account for just this occasion. According to my insurance literature:

In addition to your covered-in-full (after applicable copay) eyeglass benefit UHV also offers a safety eyewear plan,,,With UHV's safety eyewear plan, safety glasses are covered without a copay. You will receive a(n),,,allowance toward the purchase of safety frames,,,or a $69 retail allowance at network retail providers. In addition, polycarbonate lenses with side shields are covered-in-full,,,This safety eyewear plan is separate from your regular benefits plan, and your selected eyewear must included both safety frames and lenses.
So how should I read this? Are my safety glasses "free" if I stay under $69 ($139 if PPE account is included)? Something I will have to ask my HR person.

If this holds true then my total out-of-pocket expenses would be $20 which IMHO makes the $75/mth I pay totally worth it. (I will be having dental work done in next few months also.)

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