For many Canadians, quality vision is an ability taken for granted until we experience impairment. Whether it’s a prescription change, eye strain from our increasingly screen-centric work environments or a disease that gradually damages sight, the ability to access vision care when it’s required considerably enables our ability to perform on a daily basis.

Vision loss and vision problems are big ticket items for the economy and at work. In 2019, the National Coalition for Vision Health estimated that vision loss could cost the economy $30 billion per year by 2030 and a 2011 study by the Canadian National Institute for the Blind estimated $4.4 billion annually in productivity losses alone. 

In 2016, nearly a million Canadians missed work or school because of vision problems, according to a survey by Nanos Research. And a 2013 study by the International Federation on Ageing found those with vision problems incurred higher non eye-related medical costs than those without vision loss and may access other types of benefits, such as short- and long-term disability, due to their vision issues and its effects on their mental health.

Read: Employers grappling with poor optics of employee vision coverage

In addition, vision care benefits have rarely been reviewed or adjusted over time, which means they fail to reflect changes in new optometric technologies and modalities or changing workplace demographics and needs, resulting in a high cost burden on Canadian employees.

Indeed, a 2018 trends survey by the Canadian Institute for Health Information found about 74 per cent of private vision care expenditures are incurred by Canadians out of pocket, compared to 37 per cent for drugs and 44 per cent for dental. Since cost is a factor for the majority of Canadians when deciding to access vision care services, this high out-of-pocket burden causes some Canadians to forego the routine and preventive care that would maintain or improve their eye health, preserve vision and enable workplace productivity.

For plan sponsors, vision care coverage is a balance of employee health needs and budgetary considerations. Despite enormous changes to vision care clinical practice guidelines and the standard of care and technological breakthroughs in optometric modalities, plan sponsors have been reluctant to discuss vision care benefits for fear of dollar-for-dollar increases. As a result, evolution in that are has been stagnant and the value that a redesign could have on employers’ bottom lines has been largely overlooked. But in 2020, this is changing.

Read: Sanofi survey finds low employer satisfaction with benefits for vision, major dental care

Plan sponsors are putting more emphasis on how they support the eye and vision health of their employees, particularly for those in safety-sensitive positions. 

This year, the Canadian Association of Optometrists is bringing gaps in vision care benefits to the attention of the benefits industry and developing cost-effective solutions that will meet the needs of plan sponsors.

Beyond corrective lenses and frames, recent medical and technological advances mean that a regular comprehensive eye exam may now include early detection and monitoring of conditions like diabetic retinopathy, glaucoma, age-related macular degeneration and dry eye disease through the use of digital fundus cameras, optical coherence tomography and retinal cameras. Vision care plans designed 20 or more years ago couldn’t conceive of these technologies and how the optometry profession could use its expertise, combined with the technology to deliver substantially more value to Canadians and their employers.

The 2019, the CAO commissioned a white paper on the state of vision care benefits in Canada. The paper identified the specific gaps in private group plans that result in Canadians paying out of pocket for the majority of expenses for clinically important vision care services. 

The CAO is also focused on ensuring plan members have access to required care, while delivering the greatest value to plan sponsors and respecting benefits plan budgets.

Read: Have your say: Is vision care coverage too low?

Recognizing the need for cost-effective and budget conscious plan design solutions, the CAO subsequently developed a guidebook, Best Practices Guide to Vision Care Benefits, to be released this month. It provides plan sponsors, advisors and insurers with a summary of clinical practice guidelines reflecting current standard of care in optometry, including for routine eye exams and for diagnosis treatment and management of several conditions affecting eye health and vision, currently available vision care services, fee ranges and new recommended plan designs.

Denise Balch is president of Connex Health Consulting and Ibrahim Daibes is director of policy, research and advocacy at the Canadian Association of Optometrists.

Copyright © 2021 Transcontinental Media G.P. Originally published on benefitscanada.com

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Chris Pryce, CEBS:

Denise and Ibrahim, you raise some excellent points. The insurance industry has indeed failed to innovate. Innovation is often seen as allowing laser eye surgery.

Based on your piece, I think there is a legitimate case to moving some of these services under the extended health benefit of plans as these are legitimate health considerations. One may argue, even moreso than a benefit like massage therapy.

With so many people staring at computer screens, we really should be taking this benefit more seriously. Traditionally, we have discouraged clients from traditional lens and frames vision benefits as it is a benefit for which no one truly benefits. The employee is unhappy because they only received $200 reimbursement on a $600 purchase. So the goodwill from the plan sponsor is tainted with resentment. The plan sponsor is unhappy that the employee is unhappy and then questions why they are paying 30% admin fees on a fully insured plan to cover an expense that is not insurance and for which also generates some resentment at claim time.

In our practice, we have had some success in carving this and perhaps paramedicals out of a health-care spending account. The client then pays 1/3 lower admin fees — and that is great — but the client, at that point, has to understand and acknowledge the tax-effective nature of benefit plans and what benefits like this can and are meant to do for plan member engagement. Only then, do we find that the plan sponsor will consider making the decision to enhance vision benefits.

Unfortunately, few companies think of their benefits plan in this way and fewer still have or leave themselves with the budget to enhance these sorts of services.

Wednesday, August 26 at 11:12 am | Reply

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