Vision Lab Choice Act of 2025
The Vision Lab Choice Act of 2025 would add a new section (2719B) to Title XXVII of the Public Health Service Act to improve vision-care coverage in group health plans and vision insurance. Its core provisions limit the initial and extended contract terms between group health plans/issuers and doctors of optometry, require freedom for optometrists to choose laboratories and suppliers, and create a federal-state enforcement mechanism so states can regulate compliance. The bill also defines a doctor of optometry, makes a conforming amendment, and preserves state-law authority where it directly governs health insurance issuers and limited-scope vision plans, meaning state law remains the controlling rule where applicable. In practice, the bill aims to give optometrists more manageable contract terms, prevent plan-imposed restrictions on where they obtain services or materials, and rely on annual federal-state coordination to ensure enforcement. It could improve provider autonomy and patient access within vision benefits, while adding certain compliance requirements for plans and issuers.
Key Points
- 1New Section 2719B: Establishes rules for improving coverage under vision plans, specifically for group health plans and individual/group vision insurance offering vision benefits (including limited-scope plans).
- 2Duration of limited-scope vision plan contracts: For doctors of optometry with plan agreements, the initial contract term cannot exceed 2 years; any extensions require the doctor’s prior acceptance and may be for up to 2 years each; extensions may continue indefinitely in 2-year increments if agreed.
- 3Respect for optometrist choice of labs/suppliers: Plans and issuers may not restrict or limit a doctor of optometry’s ability to choose laboratories or suppliers of services/materials provided to enrollees.
- 4Enforcement and state cooperation: The Secretary must annually notify states of their authority to enforce these provisions and seek confirmation on enforcement. If a state declines to enforce or does not respond within 90 days, the state is treated as not substantially enforcing these provisions for purposes of specific enforcement provisions.
- 5Definitions and cross-references: Defines a “doctor of optometry” as one licensed where they practice; adds a conforming amendment to existing PHSA provisions; and clarifies how these changes interact with state law.
- 6State-law supremacy where applicable: State law that directly governs health insurance issuers and vision benefits retains exclusive jurisdiction where it conflicts with federal amendments, and states retain control over plans that are directly governed by the state.