- Does the employer have to pay anything?
- Do I have to choose just one plan for Voluntary?
- I see that the prices are lower for Mandatory, how does Mandatory work?
- Can I choose a Silver Mandatory plan, but allow employees to upgrade to Gold or Platinum if they want to?
- How long is the initial contract?
- Can my bank account automatically pay for this each month?
- Are plan payments pre-tax?
- Is there a waiting period to use the plan?
- When does my benefit renew?
- If we take the Voluntary plan, can an employee switch plans mid-year?
- If one of my employees has vision through a spouse (or another job), do they have to join a Mandatory plan?
- Can owners, board members, or partners sign up even if they aren’t technically employees?
- Can seasonal or part-time employees take Optilegra?
- What happens if one of my employees takes the plan, and uses the benefits… but retires, quits, or dies before the end of the year? Do we still have to pay for their plan?
- Can an employee obtain COBRA when they no longer work here?
- Does one of your plans offer glasses AND contacts each year?
- How old can children be on the plan?
- We have a couple of employees who are husband and wife. Do they go together to make a family plan?
- Do we get member ID cards?
- What’s the deadline for signing up?
- How much does LASIK cost, and what surgeries are included?
- What does it mean when you say “Optilegra is a membership plan, not vision insurance”?
- I’m interested, but my business only has one employee, do you have an individual plan?
- Is it worth it to get a vision plan if I’m on Medicare?
- Can my plan be used for sunglasses, reading glasses (a.k.a. “cheaters”), or cosmetic contacts?
- Can my plan be used for polycarbonate, Trivex, hi-index, or glass lenses?
- Are industrial safety glasses included?
Does the employer have to pay anything?
No. Any Optilegra plan can be deducted entirely from the employees’ payroll. (pre-tax) No cost to the employer at all. Many businesses simply offer a voluntary plan to their employees and let them decide whether or not they would save money with a vision plan.
Do I have to choose just one plan for Voluntary?
No. With a voluntary plan, each employee can choose Silver, Gold, Platinum, or no plan at all, based on their family’s needs.
I see that the prices are lower for Mandatory, how does Mandatory work?
For Mandatory rates, all benefit-eligible employees take the same plan, whether they need glasses or not. Your business can pay for this, it can be payroll-deducted, or some combination of both.
Can I choose a Silver Mandatory plan, but allow employees to upgrade to Gold or Platinum if they want to?
Yes! You may choose to give your employees the option to upgrade to Gold or Platinum at their own expense. (i.e. you would payroll deduct more from employees who choose to upgrade.) However, pricing for the upgrade options is at the voluntary level (not mandatory).
How long is the initial contract?
Our standard contract is 24 months. After the first 24 months the plan will automatically renew, unless you inform of any changes or termination. Renewal information will be sent out 75 days prior to the renewal date.
Can my bank account automatically pay for this each month?
Yes. Optilegra allows you to do both one-time and monthly ACH (bank-draft) payments. You can choose to have your payments recur on any day of the month. (1st, 2nd, 20th, 31st, etc.)
Are plan payments pre-tax?
Yes. All vision plan payments are pre-tax, both for the employer and employee.
Is there a waiting period to use the plan?
Nope. If you sign up Jan 1, you can get your eyes checked on Jan 1.
When does my benefit renew?
Benefit frequency is based on the Member’s Date of Service. Benefits renew one or two years from the time they are used.Back
If we take the Voluntary plan, can an employee switch plans mid-year?
Employees can only change plans (or stop taking the plan) during the open-enrollment period (the month prior to the plan’s renewal date). They commit for 12 months each year at open enrollment.
If one of my employees has vision through a spouse (or another job), do they have to join a Mandatory plan?
No. If one of your employees already has a vision plan (e.g. Optilegra, VSP, Avesis, EyeMed, etc.) they do not have to join a Mandatory plan.
Can owners, board members, or partners sign up even if they aren’t technically employees?
Yes, provided that they are eligible for the other employee benefits at your business.
Can seasonal or part-time employees take Optilegra?
Seasonal employees cannot. For part-time, the employee must be eligible for your other employee benefits and willing to commit to taking the plan for 12 months at a time (or 24 months for Silver).
What happens if one of my employees takes the plan, and uses the benefits… but retires, quits, or dies before the end of the year? Do we still have to pay for their plan?
No. This is a standard qualifying event that allows you to take that employee off your company vision plan. Her plan would stop at the end of whatever month the event happened in.
Can an employee obtain COBRA when they no longer work here?
Does one of your plans offer glasses AND contacts each year?
No. Each year the member can choose to use the glasses benefit or the contacts benefit. If they have the Silver plan, they cannot choose glasses 2 years in a row, but they could take Glasses the first year, Contacts the second year, and Glasses the third year.
We do offer Materials Only plans that can be added alongside our standard plans. If someone has, let’s say, a standard Gold Plan and a Gold Materials Only Plan, they could get 2 glasses, 2 orders of contacts, or one of each in a given plan-year.
How old can children be on the plan?
Optilegra uses the same dependent criteria as the group health insurance policy at your business. If you don’t have a group health plan, then they are eligible up to the child’s 26th birthday.
We have a couple of employees who are husband and wife. Do they go together to make a family plan?
If you take a Mandatory plan, each employee would have to have their own separate enrollment (even if they are married to another employee). If you are doing Voluntary, the employees can choose if they want to take separate plans or combine into a family plan.
Can I enroll our employees online?
Yes! Once we received a signed contract, we will create a username/password for you on our website. This access will allow you to enter employees and dependents. If you have a small company, you can simply add everyone in less than 5 minutes. But, if you’d rather have us add your members, just send in the enrollment forms.
Do we get member ID cards?
All enrollment info is on our website. Members (and providers) can access it using the member’s last name and DOB. Members access their profile through the Members section, here.
We don’t have traditional “membership cards” that have a MemberID number on it. We do, however, send out generic business cards for employees to stick in their wallet, so they can remember which vision plan they have and how to check their benefits.
What’s the deadline for signing up?
We can start your vision plan at the beginning of any month. We can even start it at the beginning of a month we’re currently in, but we cannot pro-rate the price. For example, if you wanted to start a plan effective Jan 1, but didn’t get the paperwork to us until Jan 20, we would invoice you for a full month, even though your employees weren’t able to use the benefit for the first 20 days.
How much does LASIK cost, and what surgeries are included?
There are several different kinds of corrective surgeries for different kinds of eyes. Depending on the type of correction you need and the dimensions of your eyes, the surgeon will guide you toward the procedure that will give you the best, longest-lasting results. The actual procedures included are LASIK, LASEK, Refractive Lens Exchange, Small Incision Lenticule Extraction, Photorefractive Keratectomy, Conductive Keratoplasty, and Phakic Implants, and the pricing for each of these varies. Ask one of our surgeons for a consultation to get more information.
With an Optilegra plan, there is a $600 discount on these corrective surgeries ($250 per eye on the surgery and $50 per eye on the post-op care). The Optilegra discount cannot be combined with other discounts or promotions.
What does it mean when you say “Optilegra does not cover eye-related diseases, injuries, or other medical issues”?
We include that statement on many of our documents to make sure people aren’t confused into thinking that they would be covered for health issues with their eyes. Otherwise, someone might think that if they get poked in the eye or diagnosed with glaucoma, our plan would “cover” it. All eye injuries and diseases are medical issues and thus fall under health insurance. If someone doesn’t have health insurance, and has a medical issue, Optilegra will not help their situation.
Optilegra is a limited benefit vision insurance plan. If you take the plan, you are entitled to (for example) one eye exam per year, and a pair of glasses every 2 years (or a contact lens allowance every year). If you break your glasses, you would still have to wait the 2 years to use Optilegra again.
The benefit of having Optilegra is receiving substantial savings on eye care costs. Instead of paying $150 for an eye exam, you just pay the exam copay (typically $20). Instead of paying $300-$500 for glasses, you can get a basic pair for just the materials copay (typically $20) and pay for any upgrades that you’d like.
I have an Optilegra document that says “Optilegra is a membership plan, not vision insurance”. What does that mean?
Prior to 2018, we were classified as a discount medical plan (not vision insurance) and so many of our older documents have that disclaimer. In 2018 we worked with the South Dakota Division of Insurance to transition into proper vision insurance.
I’m interested, but my business only has one employee, do you have an individual plan?
No, not at this time.
Is it worth it to get a vision plan if I’m on Medicare?
Medicare will pay for your eye exam only if your eyes have a medical diagnosis (e.g. cataract, glaucoma, etc.). Medicare does not pay for glasses or contacts. Getting Optilegra would make sure that your eye exam is discounted and help you save a lot of money on your glasses.
Can my plan be used for sunglasses, reading glasses (a.k.a. “cheaters”), or cosmetic contacts?
Vision plans are for glasses and contacts that require a prescription. Plan benefits cannot be used for glasses and contacts that can be purchased without a prescription.
Can my plan be used for polycarbonate, Trivex, hi-index, or glass lenses?
Optilegra’s plans generally include CR-39 plastic lenses, which are the industry standard. Some plans also include polycarbonate or other lens materials, and if your plan does, it will be noted on your eligibility certificate. In any case, a member may still purchase glasses made with a different lens material, but they will be responsible for the upgrade cost. (For example, if a clinic charges $70 for standard CR-39 plastic lenses, and you would like glass lenses, which cost $100, you would be responsible for the $30 overage.)
Are industrial safety glasses included?
Safety plans are tricky, and Optilegra does not offer a bona fide safety program for companies. Such plans have to meet certain OSHA requirements. It is up to the employee and their company’s safety coordinator to make sure they have eyewear that’s appropriate for their workplace. Sometimes the safety coordinator has a list of compatible frames or brands or material requirements.
For this reason, the Optilegra benefit cannot be used for safety eyewear. An employee certainly can use their Optilegra benefit for the eye exam when getting safety wear and they can use the glasses benefit for a pair of dress glasses. But we can’t help with the purchase of the safety glasses themselves.