OnePlan Optometry Network

 

 

 

Overview

 

Network plans are a type of health insurance plan where the insurer contracts with specific healthcare providers, such as doctors, hospitals, and clinics, to create a network of preferred providers.

 

Members of these plans typically pay lower costs when they use healthcare providers within this network. Optometry network plans specifically focus on providing coverage for eye care services, including routine eye exams, prescription glasses, and contact lenses, through a network of optometrists and eye care specialists.

 

OnePlan offers optometry benefits to its members but does not restrict these benefits to a network of providers. Unlike traditional network plans, OnePlan allows you the flexibility to choose your optometrist without being confined to a predetermined list of providers.

 

Despite not offering network plans, it’s essential to understand how optometry network plans operate and their potential benefits and limitations.

 

In this guide, we will take a closer look at optometry network plans to provide you with a comprehensive understanding of your options in eye care coverage.

 

 

What is a medical scheme optometry network

 

An optometry network plan is a type of health insurance plan that focuses on providing coverage for eye care services through a network of contracted optometrists and eye care specialists. These plans are designed to offer comprehensive eye care, including routine eye exams, prescription glasses, contact lenses, and sometimes even corrective surgeries.

 

 

Benefits of Optometry Network Plans

 

• ✅ By using providers within the network, members often benefit from reduced costs for eye care services. Insurers negotiate discounted rates with network providers, resulting in lower out-of-pocket expenses for members.

 

• ✅ These plans typically cover a wide range of optometry services, ensuring that members have access to essential eye care, including preventive and corrective treatments.

 

• ✅ When using network providers, billing is often more straightforward, with fewer out-of-pocket expenses at the time of service and reduced paperwork for claims.

 

• ✅ Network providers are usually vetted by the insurance company, ensuring that members receive care from qualified and reputable optometrists and specialists.

 

 

Limitations of Optometry Network Plans

 

• ✅ Members are generally limited to a network of contracted providers. If a preferred optometrist is outside the network, services may not be covered or may incur higher costs.

 

• ✅ Depending on the size and scope of the network, members in rural or less populated areas may have limited access to network providers, making it challenging to find convenient care.

 

• ✅ Some plans may require referrals from a primary care provider to see a specialist, adding an extra step in the process of receiving care.

 

• ✅ If members choose to see an out-of-network provider, they may face significantly higher costs or have to pay the full price for services received.

 

 

When to Choose Network Plans

 

Below are some of the most important factors to keep in mind when deciding whether an optometry network plan is a good fit for you.

 

 

Provider Availability

 

📌 One of the primary factors to consider is the availability of providers within the network. Evaluate the number and locations of optometrists and eye care specialists included in the plan.

 

📌 Make sure that there are sufficient providers in your area to meet your needs. Also determine if your current optometrist or preferred eye care specialists are part of the network. Having access to your trusted providers can significantly impact your decision.

 

 

Cost Considerations

 

📌 Compare the monthly premiums, co-pays for visits, and other out-of-pocket costs associated with network versus non-network plans. It is essential to understand the financial implications of seeing providers outside the network, as these visits can incur higher fees and may not be covered by the plan.

 

 

Coverage and Benefits

 

📌 Check that the plan includes the optometry services you need, such as routine eye exams, prescription glasses, contact lenses, and any specialized treatments you may require. It is also important to check if preventive eye care, like annual eye exams, is fully covered or if there are any limitations.

 

📌If you require specialized eye care or treatments, verify that these services are included in the plan’s coverage.

 

 

Referral Requirements

 

📌 Some optometry network plans may have referral requirements, which can add an extra step in the process of receiving care. Determine if the plan requires referrals from a primary care provider to see a specialist. This requirement can affect the convenience and speed with which you can access specialized eye care services.

 

 

Geographic Limitations

 

📌 Consider any geographic limitations of the network. Depending on the size and scope of the network, members in rural or less populated areas may have limited access to network providers, making it challenging to find convenient care.

 

📌 Check that the network has a sufficient presence in your area to provide the necessary services without requiring extensive travel.

 

 

OnePlan Network Optometrists

 

OnePlan does not offer an optometrist network plan. This means that you can visit any optometrist you prefer and submit your claim for cover to OnePlan, depending on the benefits of your specific plan.

 

 

OnePlan Plans with Network Optometrists

 

In terms of network, OnePlan allows flexibility as they do not require members to stick to a specific list of network providers. Instead, members can choose their optometrists and claim the benefits as outlined in their specific plans​.

 

OnePlan does offer optometry benefits through their various health insurance plans. These plans include coverage for eye tests and lenses, with specific coverage amounts and conditions depending on the plan selected.

 

 

📢 Core Plan

Provides coverage for eye tests and lenses up to R800 per event, with eye tests covered up to R280 and lenses (single vision and bi-focal) up to R400 each.

 

 

📢 Professional Plan

Offers coverage up to R1,130 per event for eye tests and lenses.

 

 

📢 Executive Plan

Similar to the Professional Plan, covering up to R1,130 per event for eye tests and lenses.

 

 

📢 Elite Plan

Provides the most extensive coverage, up to R1,470 per event, including multi-focal lenses.

 

 

Optometry Network Exceptions

 

OnePlan does not provide a specific optometry network plan, meaning their members can choose any optometrist and claim the benefits as per their coverage.

 

However, for other insurance providers that do offer optometry network plans, here are the typical exceptions where you can use an optometrist that is not part of the network under network-based optometry plans:

 

 

✅ Emergency Situations

 

If you need urgent eye care and there are no network providers available, many plans will cover visits to non-network optometrists. This usually requires documentation and justification of the emergency.

 

 

✅ Geographic Exceptions

 

If you are traveling or living in an area where network providers are not accessible, your plan may allow you to use non-network optometrists. You might need to inform your insurance company beforehand or provide evidence of the lack of network options.

 

 

✅ Specialized Services

 

If you require specialized optometric services or treatments that are not available within the network, your plan might cover visits to non-network optometrists. Pre-approval from the insurance provider is often necessary in these cases.

 

 

✅ Continuity of Care

 

If you have an established relationship with an optometrist and ongoing treatment, some plans allow you to continue seeing that non-network provider for a certain period. This is often applicable when switching insurance plans or during the initial enrolment period.

 

 

✅ Provider Transition

 

If a network provider leaves the network, many plans will cover visits to that optometrist for a transitional period, allowing you time to find a new network provider.

 

 

✅ Referral by Network Provider

 

If a network optometrist refers you to a non-network specialist for specific care that cannot be provided within the network, this visit is typically covered, often with prior authorization.

 

 

Conclusion

 

Optometry network plans can offer significant cost savings, comprehensive coverage, and simplified billing when using in-network providers. However, they also come with restrictions on provider choice, potential geographic limitations, and possible referral requirements.

 

While OnePlan does not offer network optometry plans, it provides comprehensive optometry benefits without restricting you to a specific network of providers. Even without a network plan, OnePlan ensures you have access to essential eye care services, allowing you to make the best choices for your vision health.