New Federal Guidelines Impact Stand-Alone Vision Plans on Colorado and California Health Exchanges

WASHINGTON, D.C.—In the continuing debate over how stand-alone vision plans will participate in each state’s health insurance exchange, the Connect for Health Colorado exchange board of directors voted 5-1 to provide direct access to stand-alone vision plans for consumers via a link that appears during the health insurance enrollment process. The decision “requests authority to provide access to stand-alone vision via a link for consumers.”

While guidelines last year from the Centers for Medicare & Medicaid Services (CMS) in the Department of Health & Human Services (HHS) had left the decision up to each state how they might choose whether to include or not to include stand-alone vision benefits within its exchange, CMS issued a memo on “Frequently Asked Questions [FAQ] on Reuse of Exchange for Ancillary Products” that more specifically detailed how stand-alone vision plans and other non-essential health benefits should be handled by each state’s health insurance exchange.

In the FAQ memo, dated March 29, 2013, federal guidelines indicated that while exchanges could provide education about ancillary benefits such as vision coverage and a link for purchasing them within an exchange’s infrastructure, the actual transaction could not be completed within the exchange itself, and federal subsidies could not be used for the sale of non-essential benefits.

The issue regarding how to offer stand-alone vision plans was also addressed by California’s health benefit exchange, known as Covered California, during a board meeting held on June 20. The group decided to table its decision regarding stand-alone vision plans until a workgroup it designated to study the topic further could make a recommendation to the board. In attendance during the meeting, representatives of the California Optometric Association, the National Association of Vision Care Plans and VSP all expressed their concerns to the board that postponing the decision and delaying availability of stand-alone vision plans via that state’s health insurance exchange could leave some adults without vision coverage until it was made available.

Julian Roberts, executive director of NAVCP, explained to VMail the concerns that he and the other organizations expressed to the board of Covered California: “We did want them to understand our concerns about any delay and that it could result in a lot of adults not having vision coverage, especially if they are buying coverage through the exchange. They need to create a link and should look at the Colorado model to see how they’ll be up and running by Oct. 1.”