4 things to consider when evaluating member out-of-pocket costs


When evaluating vision benefits, every employer wants to get the best value for their employees. A key part of keeping members healthy and happy is getting out-of-pocket costs down as low as possible. Read more for the top 4 factors to consider when comparing vision plan offerings.

#1 Compare fixed member cost versus discounts

The industry has moved away from providing “cherry-picked” sample transactions and toward a more transparent model with a benefit summary of fixed copays and allowances. This helps in making an informed decision on member out-of-pocket costs with no surprises at the checkout.

Most items in an insured vision plan will have a pre-established member cost. This provides a clearer side-by-side comparison. You know exactly what your employee will pay the provider, regardless of what the provider charges. But instead of fixed pricing, some items may have a discount off retail price. It’s harder to control costs with discounts because of the variables.

For example: A vision plan gives a 20% discount off photochromic lenses. The member goes to a provider who charges them $124 — so the member’s out-of-pocket cost is about $99. But if the provider next door charges them $170 for the same lens, then the member out-of-pocket cost is $136. It’s all relative. That’s why having a transparent, comprehensive view of your plan’s offerings is the best way to ensure your employees get the best value. 

Now consider a vision plan who provides a fixed member insured cost of $50 for photochromic lenses rather than a discount. Suddenly, the guess work is gone. The member pays the same amount, regardless of how much the provider charges. This controls cost and makes a visit to the eye doctor or local retailer less daunting.

#2 Help members avoid “sticker shock”

When members are surprised with out-of-pocket costs, it’s often because they’re purchasing progressive lenses and/or anti-reflective coatings. Known as no-line bifocals, progressive lenses are the lens for vision correction at all distances. Anti-reflective (AR) lenses have a coating that reduces internal reflections in the lens itself.

Examples of progressive and anti-reflective lens tier1

With progressives, there are many options to consider – ranging from standard to the latest cutting-edge lens technology. When comparing plans, look at how each plan controls the costs around these more expensive items. Is there a tiered range of copays? How do the copay amounts compare? Or is the provider relying on discounts, making it much harder to control costs?

Know Before You Go cost calculator

EyeMed makes it easy for members to estimate their costs up front with our Know Before You Go cost calculator. Through this transparency tool, members can choose services and products and see their plan-specific out-of-pocket cost total (if any). This includes easy-to-understand explanations of types of frames, lenses, add-ons and contacts – and easy scheduling through our enhanced Provider Locator search tool

It’s clear to see why 99% of EyeMed customers agree our benefits are easy to understand.2

#3 Focus on utilization and what really matters

Our data shows that 70% of EyeMed members use vision benefits to buy glasses and 30% purchase contacts.Don't get distracted evaluating features that may not be as relevant to your employees' benefit utilization.

For example: a low copay for something like polarized lenses is great. But when you consider that only 4.6% of claims will be applied toward polarized lenses, don’t sacrifice a lower exam cost for this less utilized benefit. In other words, don’t sweat the small stuff.

Here’s how we think your employees may use their benefit when purchasing lenses4

60% of all EyeMed members’ lens transactions are polycarbonate coating with antireflective coating.1

#4 Pay attention to special offers that can enhance savings

Finally, lower out-of-pocket costs may not show up in the benefits summary. To minimize member out-of-pocket, you have to factor in additional special offers members can take advantage of. When these special offers are combined with the plan benefits, it can add up to truly remarkable savings.*

  • 40% off additional pairs of glasses
  • $0 copay on an eye exam
  • Up to 88% savings through Eye360
  • 15% off LASIK or 5% off promotional pricing
  • Discounts through EyeRewards member program

Reach out to your EyeMed representative and discuss how to compare vision plans to maximize member value – or visit eyemed.com to learn more.


1 – Based on EyeMed Insight network book of business claims analysis comparing national averages of progressive lens tiering to publicly available information from industry competitor, 2021. Lenses in each tier vary by vision benefits organization.

2 – Client Satisfaction Survey completed by clients, conducted by Walker, 2020. National/Strategic clients only. Excludes SMB clients.

3 – Based on EyeMed national book of business claims, 2021.

4 – Projections that represent our assumptions and expectations based on EyeMed national book of business claims, 2021. These projections are also based on circumstances involving other clients and industry trends that involve variables, risks and uncertainties. Your actual experience and results may differ from those projected in this report.

*Savings not available in all states and not available at all In-Network provider locations. Fully insured clients are underwritten by: Fidelity Security Life Insurance Company®, Kansas City, MO 64111 and Fidelity Security Life Insurance Company of New York®, Kansas City, MO 64111. Discounts are not insurance.