Some public health insurance exchange managers are still thinking about adding vision benefits coverage.

Backers of the proposals see adding vision benefits programs as a way to help consumers, generate commission revenue or fee revenue for the exchange programs, and, possibly, expand insurance company support for the Patient Protection and Affordable Care Act (PPACA) exchange system.

See also: Exchange wants ancillary product partners

The U.S. Department of Health and Human Services (HHS) requires public exchanges to offer major medical coverage and encourages them offer dental insurance. It lets them offer stand-alone vision coverage, and it lets them provide access to landing pages that direct consumers to outside websites that sell other types of products, such as disability insurance or long-term care insurance.

In the District of Columbia, for example, companies that sell dental insurance and vision insurance, but not major medical coverage, have complained about the district taxing them to pay for exchange operations even though the DC Health Link exchange does not let them sell products through the exchange.

The board of Covered California, California’s state-based exchange, talked at a recent meeting about a proposal to offer links to vision plan issuers’ websites as early as the 2016 open enrollment period, which is set to start Nov. 1.

Any California-licensed insurer in good standing could pay for a vision plan link.

The exchange is thinking about charging a $1,000 request-for-proposals (RFP) application fee from would-be vendors and a $10,000 implementation fee. It could collect 10 percent first-year commissions in 2016, and 5 percent first-year commissions in later years.

After 2016, Covered California could integrate the system more closely with the main qualified health plan (QHP) sales system and use an “active purchaser” plan issuer negotiation process similar to the process the exchange uses to create the QHP menu, officials say.

The exchange intends to issue an RFP in September and have vision plan issuer links on the Covered California website by November.

Jen Flory of the Western Center on Law & Poverty wrote on behalf of a list of organizations that includes Consumers Union, Health Access, National Health Law Program and California Pan-Ethnic Health Network that the groups hate the idea of Covered California offering a branded link to a vision plan issuer that pays the exchange commissions without getting much exchange oversight.

“While Covered California staff has been working to improve its staffing and systems, all too often, considerable effort is required to resolve individual consumer problems,” Flory writes. “To introduce a new, unsupported program in this context risks further reducing public faith in the Covered California brand while at the same time offering a product Californians can purchase on their own.”