Ryerson University carries an impressive vision-care package: non-unionized employees can spend up to $800 every two years on glasses, contact lenses and laser eye surgery and receive an eye exam every two years.
When the university’s union groups negotiated higher coverage for vision care, it only made sense for the non-unionized groups to follow suit, according to Jan Neiman, manager of pensions and benefits at Ryerson. Benefits plans for universities are generally similar for all employee groups to ensure equity, she says.
Before 2012, Ryerson offered coverage for eye exams but had a lower vision-care budget: $300 for glasses and $300 for contact lenses. After employees asked for higher spending limits, the university decided to combine the two pools of money, add an additional $200 and expand the plan so it also included laser eye surgery.
“We want to offer a really good program,” says Neiman. “It was very visible that being able to get glasses and contacts were high on people’s list. They seemed to zero in on that.”
Ryerson employees aren’t alone in wanting more vision-care funding. The 2016 Sanofi Canada health-care survey revealed 91 per cent of plan members said vision care is somewhat or very important to them. They ranked it third in importance, just below prescription drugs and dental coverage, but only 35 per cent described their vision-care benefits as good or very good.
The survey results were surprising, says Joan Weir, director of health and dental policy at the Canadian Life and Health Insurance Association. It was clear from the feedback that employees want plan sponsors to pay more attention to the vision-care aspect of a benefits plan, she says.
Although most plan sponsors understand the importance of vision care, many have chosen to keep their coverage stagnant for years, says Marilee Mark, vice-president of market development for group benefits at Sun Life Financial. “It’s an essential part of the plan in most cases. . . . It’s only a question of the dollar amount.”
According to several insurance providers, the current range of spending limits for vision care, which typically includes contact lenses and glasses, is anywhere from $100 to $400 per person every two years, depending on the plan sponsor’s size and budget. A common amount is $200.
The challenge is the budgeted amounts aren’t enough to cover the costs for most prescription eyewear in the marketplace, says Mark. “You can spend $150 and get a basic pair of glasses or you can spend $600 to $700 to get designer frames and glasses. . . . There’s a broad range.”
While vision-care limits haven’t risen to reflect inflation, increasing the budget to close the gap hasn’t been a priority for most employers, says Kenneth MacDonald, a senior consultant at Morneau Shepell.
That disparity between vision-care benefits and actual costs has always been “a lighting rod of discontent for employees,” says Brian Lindenberg, senior partner and health and benefits leader at Mercer. However, the idea was never to fully cover the costs but to reduce them, he says.
The coverage reflects the notion that vision care is something plan members can budget for, as opposed to other benefits such as disability insurance or prescription drugs, says Mark. And with so many benefit components on the table, plan sponsors face tough decisions on where to allocate their overall budget, she notes.
Competing with other benefits
The need to balance competing priorities may be one reason why organizations have historically overlooked vision care, says Weir. “One of the things [the Sanofi survey] drew our attention to is that plan sponsors have been putting more emphasis on the two biggest cost drivers in plans: drugs and dental. So maybe it’s time to put more attention to that third piece of the benefit plan.”
Like employees, plan sponsors seem to be equally unhappy with vision care. According to the 2016 Sanofi survey, only 15 per cent of employers expressed satisfaction with their vision-care plan. Among the reasons for the dissatisfaction are the perception that the plan doesn’t deliver value and the high costs.
A key challenge with vision care is the fact that it provides a catch-22 for plan sponsors, says Gord Simle, a Calgary-based benefits consultant. “It will always be viewed as not enough coverage, because the benefit will never equate to what [employees are] paying for.”
Simle says the wide availability of insurance programs in Canada has helped drive up the costs of glasses. “Vision suppliers charge through the nose for them because they know they can. They keep raising prices.”
The majority of the cost usually goes towards frames, says Simle. “For the average person, $175 is probably for lenses and $300 for frames.”
Employees are unhappy because their benefit limit of $200 isn’t enough to cover the full cost, but the reality is the plan does cover the lenses, which is the medically necessary portion of the product, says Simle. As a result, plan sponsors can never win with employees as they’ll often be unhappy with their coverage.
For patients with more complicated prescriptions, the cost of glasses is even higher, according to Dr. Krista McDevitt, former president of the New Brunswick Association of Optometrists. High-quality glasses can exceed $600 for those with single-vision lenses and $1,000 for people who need progressives, she said, suggesting that vision-care benefits are “notorious for being out of step with the standards of care for vision health.”
Most people don’t see the major differences between lenses, but they are in fact significant, McDevitt noted in response to questions about vision-care coverage. “Think of buying a disposable camera, versus a top-of-the-line Canon or Nikon camera.”
Employees seeking affordable prescription eyewear
To address the low budgets for vision care, some insurers offer preferred providers that offer discounts for glasses, says Weir. But Weir has also noticed employees have started looking online for cheap eyewear.
The trend, however, is a concern for optometrists, says Brian Wik, executive director of the Alberta Association of Optometrists. The organization has been trying to spread awareness about the risks involved with buying prescription eyewear online.
There’s a high potential rate of error, says Wik, referring to a study by the American Optometric Association that found 44.8 per cent of glasses bought online had incorrect prescriptions or safety issues.
Unlike opticians and licensed providers, online vendors don’t answer to industry standards, according to the New Brunswick Association of Optometrists’ McDevitt. “Patients are able to input any changes to the prescription they erroneously deem necessary or order any contact lens design/brand that they erroneously think may suit and fit them properly.”
People should consult optometrists who provide accurate prescriptions and recommendations based on lifestyle factors before they buy glasses, says Wik.
As well, McDevitt suggests it’s alarming for insurance providers to cover eyewear from non-regulated providers. “It is shocking and disheartening to us as a profession.”
What plan sponsors can change
Traditional benefits plans combine coverage for eye exams and prescription eyewear, says Simle. But some insurers, such as Sun Life, will include eye exams under medical services — along with coverage for other practitioners, such as massage therapists and physiotherapists — and offer vision care as a distinct and added benefit.
Some plan sponsors are also taking action to address plan members’ concerns. In July 2016, the University of Toronto restructured its vision-care package to make eye exams a separate benefit. It was important to distinguish eye exams for employees who want regular eye checkups but may not necessarily need new glasses, says Steve Dyce, director of benefits and pensions. “It’s a good preventative practice. Eyes are something we need to make sure people are taking care of and that they’re identifying any problems early with vision.”
In addition to separating the benefit for eye exams, the university changed its vision-care plan in 2015 by boosting the maximum coverage for prescription eyewear to $400 from $350 every 24 months.
“We know eyeglasses and prescription eyewear is valued and it’s a high-utilization benefit,” says Dyce. “If we can make any change to a benefits plan to improve the satisfaction of employees, [vision care] is one that impacts the majority of people.”
Public coverage for eye exams lacking
Plan sponsors may not be the only ones overlooking vision care as Canadian public health-care plans typically cover eye exams only for children and seniors.
In most provinces, working-age people between 18 and 65 years of age don’t receive funding for eye exams, unless they have an existing condition, such as diabetes, that puts their ocular health at risk.
The lack of coverage is astounding because eyes should be part of health care, says Diane Bergeron, executive director for strategic relations and engagement at the Canadian National Institute for the Blind. “You go get your physical from the doctor every year, but eye health is considered totally different and that doesn’t make sense to me because how important is your sight?”
As a result of the lack of vision-care support for working-age Canadians, the responsibility has fallen to private insurers, says Weir. “[We’ve] kind of had to pick up that coverage.”
However, not all plan sponsors provide funding for eye exams in the first place, says Simle. And those that do usually provide less than $100 every two years.
That amount isn’t enough to cover the full cost of a comprehensive eye exam today, says Dr. Barry Thienes, president of the Canadian Association of Optometrists. “[Exams] run more into the $100 to $150 range.”
The complexity of eye exams has evolved over time, and optometrists now do more than conduct a simple vision or sight test, says Thienes, noting they use advanced technology to look at overall vision health and for any symptoms that signal ocular issues.
According to the CNIB, it’s possible to prevent vision loss, which carries a $19.1-billion annual cost in Canada, through regular eye exams that can detect diseases such as age-related macular degeneration, glaucoma and early-stage diabetic retinopathy.
“We spend a lot of time looking at health and safety in the workplace, and there are lots of workplaces with wellness programs, but a lot of benefits don’t include eye exams or address what you can to do prevent sight loss,” says Bergeron.
For instance, it’s common for many employees to experience chronic dry eyes because they spend long hours in front of a computer, says Thienes. “It’s not only that optometry has evolved, but the treatment of these conditions has evolved in the last couple of years. I don’t think that insurers have kept up with that and realized that the people they’re insuring have bigger demand for their eyes.”
Canadians between the ages of 20 and 40 tend to neglect going for regular eye exams, unless they have an obvious sight problem, says Thienes. However, because many jobs involve a computer, small vision corrections can actually make a big difference in how people perform at work, he adds.
Giving employees more ownership over benefits
Plan sponsors have also attempted to alleviate dissatisfaction with vision care and other benefits by offering health-care spending accounts to employees, says MacDonald. “Rather than fixing those specific program elements, they’ll say, ‘We’ll give employees a health spending account,’ or, ‘We’ll increase the amount of the health spending account that we have,’ and employees can then spend those dollars wherever they need it.”
Providing spending accounts, as opposed to raising the benefit limit, is appealing to plan sponsors because it’s less expensive, notes Simle. When a plan sponsor raises the limit, it also has to account for plan members who have dependants using the benefit, he says.
As well, unlike specific benefits, health-care spending accounts are typically a stable cost for plan sponsors, says MacDonald. “So that cost remains more static to employers,” he says.
The increasing popularity of spending accounts signals a shift towards a defined contribution approach in benefits plans, says Mark. Under that model, plan sponsors are giving employees ownership over their plans by allowing them to put more money in spending accounts and less towards certain benefits, she says. While employees still receive basic insurance coverage, they can increase the dollar amount in their spending accounts and reduce benefits in other areas, such as dental and paramedical services, if they wish.
Despite the attraction of a defined contribution approach, it may be a challenge for plan sponsors to ensure it works effectively. According to the 2016 Sanofi survey, only 35 per cent of employees are satisfied with health spending accounts.
As Mark points out, the process of submitting claims can deter members from making use of their accounts. “People forget that they have them and there’s a limited time period to use them. If we had more people understand how they can submit claims easily, there may be higher satisfaction,” she says.
Health spending accounts are ineffective if people don’t know how to leverage them to boost the low coverage limits for vision care, according to Simle. “It’s how you use the account with the rest of the benefit,” he says. “Tell people that if vision is their priority, they can buy glasses [under vision care] and supplement it with a health spending account.”
Apart from educating employees, plan sponsors need to reassess their benefits framework every few years and “recalibrate them” to make sure they still meet their objectives and employees’ needs, says Mark.
Still, MacDonald notes a benefits plan can’t please everyone. Employees tend to “cherry pick” benefits by judging the ones they use, he says. “They’re not looking at the program as a whole.”
Jann Lee is an associate editor at Benefits Canada.
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