Just don’t do it: Plano sunglasses aren’t covered
We regularly audit frame only transactions to make sure you’re following these policies. And we’ll withhold funds for any plano sunglass purchases that don’t comply.
It’s easily one of our most asked questions by both providers and
members. Does EyeMed cover plano sunglasses? In short, the answer is no.
The long answer has to do with our benefit structure, which covers lenses and frames separately. Plano sunglasses are explicitly excluded in our plan limitations. But members may have a frame allowance separate from the lens benefit,
and sometimes they want to use that amount toward a sunglass purchase. Technically they can do so—but only if the following criteria are met:
- The frames can hold a prescription lens (sometimes called an “RXable” frame).
- You either remove the plano lenses from the frame before selling them, or charge the member separately for what the plano sunglass lenses would cost if they were surfaced and/or edged, tinted and treated. (Make sure the member knows removing the lens may void the warranty.)
- You explain to the member—and use an Advanced Beneficiary Notice
(ABN) form to document your discussion—that the vision benefits don’t cover the additional cost for the lenses, and that by using the frame benefit toward sunglasses, the member cannot use the frame allowance toward the purchase of prescription eyewear until the benefit resets.
- If you don’t feel comfortable removing the lens, that’s okay. Any discount available to the member on additional purchases – usually 20% off – can
be applied to a plano sunglass purchase. The discount is often the easier and more straightforward approach when members ask about savings available on sunglasses.
So there you have it. All of this is documented in the EyeMed provider manual, along with tips for avoiding problems during an audit. Remember, if you submit frame only claims, EyeMed may require documentation to validate the benefit has been applied correctly. If you still have questions, feel free to call 888.581.3648.