GM benefit plan now covers OD-provided medical eye care

January 11, 2013

The General Motors Company (GM), the largest U.S.-based automaker, announced that beginning in January medical eye care services provided by optometrists will be covered under the health benefit programs for all of its active and retired, salaried and hourly employees in the United States.

With the GM announcement, more than 800,000 American autoworkers and auto industry retirees will have gained coverage under their health insurance programs for the medical eye care services of optometrists over just the past two years. (This equates to approximately 38 potential new patients per each active AOA member optometrist.)

The increase in coverage for optometric medical eye care services under auto industry employee health insurance programs comes as the result of a joint effort by AOA and its affiliate state optometric associations to help show plan administrators the benefits of OD-provided eye care, according to AOA President Ronald, Hopping, O.D., MPH.

Nearly 30 million American workers have now gained access to optometric medical eye care under employer-based health plans since the AOA and its state affiliates launched their outreach program two decades ago.

“This increase in patient access to optometrists for medical eye care is the result of the hard work of the AOA and its affiliates such as the Michigan Optometric Association calling on companies and advocating for these changes,” said Dr. Hopping.

The United Auto Workers (UAW) Voluntary Employees’ Beneficiary Association (VEBA), a joint self-funded retirement trust that provides health care coverage packages for some 720,000 former employees of the nation’s big three automakers, began covering the medical eye care services of optometrists on April 1, 2011 (see AOA News, April 2011).

The Chrysler Group LLC Health Care Benefits Program, which provides major medical coverage for all of that automaker’s salaried and hourly workers, began accepting claims from optometric practices for medical eye care services on March 1, 2012.

GM officials announced last month that, effective Jan. 1, 2013, all active salaried and hourly employees at parts and assembly plants for its Chevrolet, Cadillac, Buick automobiles and GMC truck lines, as well as the company’s H battery division, would be covered for medical eye care in optometric offices.

The new coverage policy also applies to all retired salaried GM workers below the Medicare eligibility age of 65. Retired hourly GM workers already had coverage for medical eye care provided by optometrists through the UAW VEBA.

GM has some 77,000 workers at 56 facilities in 10 states. The company has added 9,000 employees over the past four years as it emerged from its 2008 bankruptcy and began reactivating some facilities.

The company has 118,000 white collar retirees, many of whom took early retirement and who may not yet qualify for Medicare, and do not qualify for coverage under the UAW VEBA plan, but who will now have coverage for medical eye care provided in optometric practices.

For that reason, the new coverage decision has implications well beyond the states where GM operates manufacturing facilities, according to Peter Agnone, O.D., the AOA Third Party Center Executive Committee and Michigan Optometric Association member who worked with officials at GM and Blue Cross/ Blue Shield of Michigan, the automaker’s third-party benefits plan administrator, on the new coverage decision.

“This is important everywhere. There are GM retirees in virtually every U.S. state and territory,” Dr. Agnone said. “Rejected claims for the care of retired GM employees have been an issue for optometrists in virtually every state. The AOA Third Party Center has received requests for assistance from optometrists in not just Michigan, or other states with GM facilities, but New York, Texas, Arizona … everywhere.”

Optometrists who provide services for GM employees or retirees can file claims through their local Blue Cross/ Blue Shield plans, which will forward them to Blue Cross/ Blue Shield of Michigan, the administrator for both the GM and UAW VEBA programs, Dr. Agnone said.

Dr. Agnone believes the GM action is the latest evidence of a new attitude among employer-based health plan administrators who, largely as a result of the outreach effort by the AOA and state affiliates, increasingly see optometric practices as a convenient and cost-effective alternative for workers. Those workers might otherwise seek eye care in ophthalmology practices or emergency rooms at considerably greater cost with more time off required.

Dr. Agnone also believes that with many of the nation’s largest employers, such as GM and Chrysler, now including optometrists as providers under their major medical plans, many smaller employers may now begin considering the benefits of medical eye care provided by optometrists.

For AOA members who wish to approach local employers regarding coverage of medical eye care provided in their practices, the AOA Third Party Center and state optometric associations can offer advice and assistance. Interested practitioners can contact TPC@aoa.org.

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