Eyeglasses and vision aids

Vision aids—glasses, contact lenses, and laser eye surgery—are among the most commonly used benefits under modern supplemental health insurance plans. The reason is simple: About 60 percent of the German population wears vision aids, and statutory health insurance only covers them in rare, medically necessary cases. For employees, supplemental health insurance is often the only way to make the costs of lenses, frames, and contact lenses predictable.

What the GKV does not cover

The legal framework is clear: Statutory health insurance covers vision aids only in cases of severe visual impairment—for example, for prescriptions of 6 diopters or higher, or in specific medical situations. There is no statutory health insurance subsidy for normal nearsightedness or farsightedness in the range up to 6 diopters. In practical terms, this means that about 90 percent of all eyeglasses are paid for entirely out of pocket.

In Germany, the average cost of a complete pair of progressive lenses ranges from 600 to 1,200 euros, for a simple pair of single-vision glasses from 150 to 400 euros, and for annual contact lenses from 200 to 600 euros. The bKV covers exactly these cost categories.

Typical reimbursement models in supplementary health insurance plans

Depending on how the plan is structured, different reimbursement rules apply:

Budget rates: Vision aids are covered by the overall budget without any specific restrictions. A €600 annual budget can be used entirely for a pair of glasses. Advantage: No artificial caps. Disadvantage: Once the budget is used up, no further funds are available in the same year.

Modular plans with a separate eyewear budget: A dedicated benefit category for vision aids, typically ranging from 200 to 800 euros per year, often with a 24-month cycle (meaning the full amount must be used every two years). Advantage: Predictability. Disadvantage: Being tied to specific time intervals can be frustrating.

Percentage-based reimbursement with no cap: Plans that, for example, reimburse 90 percent of the cost of eyeglasses with no annual limit. Rare, but available with premium plans.

What is typically covered

A complete list of what is typically covered by supplementary health insurance for vision aids:

• All types of eyeglass frames, including designer brands
• Single-vision and progressive lenses in all strengths
• Photochromic and anti-reflective lenses
• Premium progressive lenses
• Prescription sunglasses (some without prescription lenses, depending on the plan)
• Contact lenses, including care products
• Computer glasses
• Laser eye surgery (often subject to specific coverage limits, e.g., a one-time limit of 1,500 euros during the term of the policy)
• Eye exam at an optometrist or ophthalmologist

One notable feature: Unlike with dental prosthetics, most supplementary health insurance plans do not require a medical necessity or a doctor’s prescription. A receipt from the optician showing the results of an eye exam is typically sufficient.

How often can you bill for a new pair of glasses?

This is one of the most common questions asked by employees. The answer depends on the pay scale model:

• Pure budget plans: As often as your budget allows. If you buy a pair of glasses for 300 euros in January and a pair of sunglasses for 250 euros in August, you’re simply using up your annual budget.
• Modular plans with set intervals: Often, the full budget is allocated once every 24 months. Some plans start at 18 months, while others have a stricter 36-month cycle.
• Annual plans: The full vision care budget once a year.

An important point to note: With budget plans, employees do not need to provide a medical justification for why they need new glasses. Fashion choices, spare pairs, and additional sunglasses—all are typically allowed, as long as the budget allows. This makes vision care a particularly user-friendly entry point into supplemental health insurance.

Computer glasses — a special category

Computer glasses have a special status: Under the Occupational Safety and Health Act, employers are required to provide them or reimburse the cost if there is a medical need for them. At the same time, they can also be billed through supplementary health insurance—either in addition to or as an alternative to standard coverage, depending on the plan.

In practice, this often leads to confusion. The pragmatic solution: cover eyeglasses through the employer’s vision coverage (a requirement under labor law), and use the supplementary health insurance (bKV) for other vision aids. A well-documented provision in the benefits plan provides clarity.

FAKTOR MENSCH : Vision aids are the number-one service by volume in nearly all of our projects—often accounting for 40 to 60 percent of all claims. Why? Low barrier to entry (no doctor’s visit required), high visible monetary value (everyone notices a 500-euro reimbursement), and most people wear glasses or contact lenses anyway. Our recommendation for the rollout: The very first supplementary health insurance campaign should focus on vision aids. This yields quick results, engages the workforce, and generates positive word-of-mouth within the teams. When someone in the break room says, “My supplementary health insurance paid for my glasses,” the viral effect is priceless.

Contact lenses as a special case

Contact lenses are generally reimbursable at the same rate as eyeglasses. Note: Annual lenses often fall within the current billing period, while monthly lenses can be submitted separately as consumables. This is not an issue with budget plans, but can sometimes be complicated with modular plans.

Contact lens care products can be included in many plans, but not all of them. It’s worth checking the plan guide.

Conclusion

Vision care is the most accessible and widely used segment of the supplementary health insurance plan and is often the most successful entry point for engaging employees. When selecting a plan, employers should look for generous reimbursement intervals, no medical necessity clause, and flexible budget utilization. When communicating with employees, the topic of eyeglasses is the perfect campaign opportunity in the first half of the year following the introduction of supplementary health insurance—success and enthusiasm are practically guaranteed.