Stand Alone Vision Plans

Stand Alone Vision Plans in California’s Health Benefit Exchange

Executive Summary

COA’s Health Care Delivery Systems (HCDS) committee was asked to develop a background/policy recommendation paper on the issue of stand-alone vision plans being excluded from the new California Health Benefit Exchange (Exchange). The purpose of this paper is to answer some key questions about exactly how optometrists will be impacted, how many will be affected and what proactive steps COA can take to prevent large patient disruptions in some private practices.

The COA HCDS committee agrees with the American Optometric Association (AOA) that eye and vision care should be integrated and not provided separately from other medical services. For years, optometrists have not been able to provide medial eye services because we are “carved out” from other medical care. However, the HCDS committee does not believe that excluding VSP and other stand-alone plans from the exchange will automatically force optometric integration in California. Health plans in the Exchange will continue to provide vision services through contracts with vision plans.

The HCDS Committee has looked at the data and the impact of the exclusion of stand-alone vision plans from the Exchange may not be as dramatic as VSP has indicated. However, doctors may experience a gradual decrease in VSP patients that may grow over time.

There are mitigating factors that make it difficult to determine the impact the Exchange will have on private practitioners. Any decrease in patients may be offset by an increase in newly insured patients who now have at least pediatric vision coverage. Additionally, vision plans are not totally excluded from the exchange. Vision plans may provide care in the exchange if they contract with a Qualified Health Plan. Lastly, VSP will still be able to sell coverage directly to employers outside the Exchange or in private exchanges.

Individual states probably do not have authority to allow stand alone vision plans in the Exchange. However, the COA has recommended some actions we can do in California that will minimize the impact on optometrists of this change. HCDS recommends COA pursue all four options described below:

1. COA should sponsor legislation that would prevent full service health plans from requiring that optometrists contract with a vision plan to provide medical services. This would encourage plans to directly contract with optometry in the same way they contract with ophthalmology.

2. COA should sponsor legislation that would allow an individual to retain their vision plan arrangement (and allow it to count under the federal law as providing the pediatric vision essential benefit) if their employer moves the purchase of their medical coverage into the exchange.

3. COA should encourage VSP to sell a product where optometrists provide all primary eye care and refer to ophthalmologists only when necessary.

4. COA should endorse VSP’s efforts to pass legislation (or regulations) that would allow stand alone vision plans in California’s Exchange. 

This is a historic time of opportunities and challenges. COA’s HCDS committee believes that these four options are the best way to address concerns about stand alone vision plans being excluded from the Exchange.