What benefit members need to understand to get the most from their benefits

image of this article's author, Chad Prittie
Chad Prittie
Regional Vice President

We’re all about eliminating surprises

What’s the most important characteristic of a health benefit? It might be transparency—making sure a benefit is clearly explained and easy for users to understand.

Transparency is the key to benefits utilization and the desired end goal of creating healthier employees. With vision benefits, transparency encourages understanding—and understanding leads to members getting the most from their benefits.
Fortunately, your vision benefit carrier and employers can help bridge communication and comprehension gaps and drive strong benefit utilization.

Employee knowledge gaps about benefits are real

Hub International’s Employee Benefits Barometer 2018 report notes that employers’ #2 benefit priority after managing costs is helping “employees make more informed decisions when it comes to choosing and using their benefits.”[1]

But research shows that benefits users’ understanding is in short supply: Approximately 1/2 of all employees don’t understand their benefits [2] , and only 4% of Americans can define basic benefit terms like “copay,” “deductibles” and “coinsurance.”[3]

With vision benefits, this lack of understanding can have real impacts. Delaying a vision exam could mean that employees might learn of chronic diseases like hypertension or diabetes early, and begin treatment sooner. And the societal cost of chronic diseases like these exceeds $5.4 trillion every year.[4]

Furthermore, slight vision issues can decrease productivity by 20% without the employee even being aware of the problem.[5]
Not only can use of vision benefits help address these issues and related health expenses early, they can help members save  significantly on eye exams, eyewear, lenses and more, compared to retail pricing without benefits. For EyeMed members, we’ve calculated the average savings to be 71% compared to retail pricing.[6]

Fortunately, EyeMed has learned how to help employees understand their benefit – and how to create a benefit that’s easy to understand and use.

Helping benefit members understand cost ahead of time

Vision benefits can get murky when employees aren’t clear about what’s included, at what frequency, at what price and how benefits and discounts are applied. People want to know how much a provider visit and related purchases will cost before they use their benefits.

One of EyeMed’s answers to this challenge is clear price tags. That means retail-based pricing on all products and services at the network provider’s location, and a “free-to-choose” model for members on products. It’s easy for members to understand, and helps them to better anticipate any out-of-pocket costs.

Another EyeMed answer is consistent application of the benefit at any provider in the network. Vision benefits can have a lot of variables and options for the member to consider. When all parts of the benefit are applied consistently across the network, the member can be confident they’re getting the most out of their benefits before ever going into their visit the eye doctor.

However, consumer-friendly pricing and benefit application models are only as good as the tools used to communicate them. Benefit carriers should offer a variety of pre- and post-enrollment educational materials to help employees “get” their benefit.

Online tools are particularly helpful, like EyeMed’s Understanding your benefit interactive feature on Eyesite on Wellness, a consumer-friendly vision care education site. Some carriers will even send experts to qualifying benefits events to walk employees through decision-making tools, explain how the benefit works, review local in-network options and more.  

This sort of hands-on, proactive approach increases engagement, and strong engagement frequently translates into higher vision benefit enrollments.

An easy benefit use experience can also boost engagement

However, where “the rubber meets the road” with benefits is after enrollment, when employees begin to use their benefits. What tools are available then to help members find providers, access services and file claims? At this stage, multi-platform support for members is crucial. EyeMed offers:

  • Welcome Packets mailed to newly enrolled subscribers, including ID card
  • A customer-care center open for calls 7 days a week with extended hours
  • Online access to an advanced provider search tool, interactive education tools and special offers that can help members further maximize their benefit
  • A members’ mobile app to get benefit information on the go
  • Ongoing education in a variety of formats—including opt-in text alerts, e-newsletters and exam reminders for at-risk patients
  • Claims that involve little or no paperwork

A great vision benefits experience means no surprise costs

You’ll know the resources worked and the communications were successful when vision benefit utilization is up and members are using in-network providers for maximum savings.

The final area when benefit transparency is vital is when any out-of-pocket charges are added up at the provider’s office. The last thing anyone wants is a bill with additional “surprise” costs. A cost estimator tool for members can help avoid nasty surprises.

Our online cost estimator tool, Know Before You Go, lets members view a menu of services and products and see the anticipated out-of-pocket cost for different options. The tool has received such positive response that we’ve recently made it available to nearly all clients.

When employees are engaged with their benefits, great things can happen

When vision benefits are transparent, the resulting gains can be impressive: higher enrollment in a cost-effective preventive benefit, healthier employees, and the potential for improved productivity thanks to vision care.

If you want to learn more about strategies for improving benefits transparency and engagement, download our free whitepaper Are your benefits feeling invisible?

I also invite you to visit eyemed.com and select “Broker Resources” to learn more about EyeMed vision benefits, or ask your EyeMed representative for a live demo of Know Before You Go.

1: “HUB International Employee Benefits Barometer 2018 Study,” https://www.hubinternational.com/-/media/1---Old-Root-Media/Employee-Benefits-Barometer-2018-Final.pdf
2: “What Employees Are Thinking About Healthcare— And why their employer needs to step it up.” (2019); Maestro Health.
3: “4 basic health insurance terms 96% of Americans don’t understand”; (2017); Policygenius.
4:  Holly, Robert, “Chronic Conditions Cost US Economy More Than $4.5 Trillion,” accessed Aug. 30, 2019, at
5: “Invigorating Interest in the Vision Benefit” (2013); NAVCP Medical Advisor Roundtable.
6.  Based on weighted average of sample transactions: EyeMed Insight network/$10 exam co-pay/$10 materials co-pay/$120 frame or contact lens allowance.