NCAR Visitor Center - One-Day Closure - Saturday 10/25 more info>

Vision & Dental Medical Emergency Coverage

Q

I’m wondering if UCAR can look at our health care policy and figure out if
there’s a way that vision and dental coverage can be provided in cases of
medical emergencies. I have insurance through Cigna. I am going to need to
have a laser eye procedure to enable me to continue functioning fully at
work and undertaking such tasks as driving in the dark, because I am so
nearsighted that even with glasses I can no longer see very well. Cigna is
not covering any of this because of a policy exclusion for the procedure (PRK).

I also have a colleague who is facing an estimated $10,000 to $15,000 of
dental work that’s needed to prevent several of his teeth from falling out.
Even though this procedure is a medical necessity, Cigna is covering only a
small fraction ($3,000 at most).

I understand why Cigna provides limited or no coverage for elective
procedures, like LASIK to improve vision or orthodontics to straighten
teeth. But our eyes and our teeth are important parts of our bodies, and I
don’t understand why even medically essential procedures would not be fully
covered.

Is it possible for UCAR to take a look at this and perhaps renegotiate our
contract with Cigna?

Answered on October 30, 2007

A

Most medical plans, including Cigna, cover injuries and diseases of the
eyes and injury to the teeth due to an accident. Medical plans do not
generally cover the eyes and teeth for “ongoing maintenance.” Dental plans
are common, but the benefit is limited to keep the plans affordable. Vision
plans are less common, as the expense is generally predictable and less
suitable to insurance, which covers unexpected losses. I am not aware of
individual plans for vision and dental coverage that would cover the
examples you mention, and even if they did, they would be unaffordable for
most people.

Your specific question about vision coverage asked about PRK. PRK, like
LASIK, is a form of surgery designed to correct refractive errors and is
considered an elective procedure, not a medical necessity. We have checked
and the UCAR plan is consistent with other plans in not covering refractive
surgery to improve vision.

The UCAR dental plan has a maximum benefit comparable to dental plans
offered by other employers. We reviewed the maximum this past year and
determined it is reasonable, and there are no plans to raise the maximum
for 2008.

Several years ago, UCAR raised the maximum under the medical spending
account to $10,000 specifically to allow employees to pay for more vision
and dental expenses on a pretax basis. (Most employer plans have maximums
around $5,000.) While the contributions to the plan come from the employee,
the pretax advantage is pretty significant. Employees can also take
advantage of a provision that allows for reimbursement even if the account
does not have enough contributions to cover the expense. Through this
provision, you can schedule PRK early in the calendar year, receive full
reimbursement from your medical spending account and pay off the cost with
pretax payroll deductions during the rest of the year.

—Bob Roesch, Human Resources Director