Confused by vision insurance terms? Use this glossary to learn some of the common vision terminology that you might come across.
Anti-Reflective Coating - A common lens coating that allows more light to pass through, eliminating reflections from the surface of the lenses. This coating reduces eye strain, improves vision, and is helpful for night driving. It also allows others to see your eyes rather than the light reflecting off the lenses.
Benefits - The amount/discounts that are covered by insurance or are reimbursed for each covered product or service.
Bifocal Lenses - Lenses that have two distinct optical powers. They are prescribed for those who need correction for both up close and far away.
Claim - A request for payment or reimbursement of benefits.
Copay - A certain dollar amount a member must pay for a specified service at the time of the service, depending on their vision plan.
Dependent - A spouse or a child of the member who meets the dependent criteria outlined by the employer.
Disposable Contact Lenses - Contact lenses that are designed to be discarded daily, weekly, bi-weekly, monthly or quarterly.
Eligible - When a member is qualified to receive benefits during a certain date range.
High Index - A lens that is lighter and thinner than conventional material. Offered for nearsightedness to those with strong prescriptions.
Lens Add-on/Option - Any option or upgrade beyond the basic lens. This may include polycarbonate, scratch-resistant coating, tint and UV coating. Add-ons listed on a plan are considered standard. Most add-ons also have premium options available.
Lenticular Lenses - Used to create strong prescriptions that cannot be achieved with a traditional lens. Bifocals would be a simple example of this type of lens. They are sometimes used to correct extreme hyperopia (farsightedness). To create the lens, one lens is bonded to the center of another to reach the correct power.
Medically Necessary Contact Lenses - Contact lenses are considered medically necessary if the individual is diagnosed with one of the following conditions:
- Anisometropia of 3D in meridian powers.
- High Ametropia exceeding –10D or +10D in meridian powers.
- Keratoconus when the member’s vision is not correctable to 20/25 in either or both eyes using standard spectacle lenses.
- Vision improvement other than Keratoconus for members whose vision can be corrected two lines of improvement on the visual acuity chart when compared to the best corrected standard spectacle lenses.
Network (in-network) Provider - The doctors, clinics, health centers, medical group practices, facilities and other professional providers that a managed care organization has selected and contracted with to provide health care for its members. Going to an in-network provider will mean you receive discounts for the services provided that providers have agreed to in their contract with us.
Out-of-Network (OON) Provider - A professional provider who does not contract with your insurance. Visiting an out-of-network provider may result in higher out-of-pocket fees for the member.
Patient Allowance - A fixed dollar amount that may be applied toward the payment for a professional service or material as specified by your plan found in your benefit booklet.
Photochromic Lenses - Lenses that change color based on the level of light where you are. When exposed to sunlight, the lenses darken. When exposed to lower light (indoors), they lighten.
Plastic Lens (basic lens material) - A commonly used lens material, chosen because it is lighter in weight than glass.
Polarized Lenses - This type of lens add-on cuts down on glare from the sun. They are ideal for outdoor sports as well as driving or outdoor activities.
Polycarbonate Lens - A lens material that helps create a more impact-resistant lens.
Progressive Lenses - Lenses that allow for a seamless multifocal field of vision - with no visible lines.
Provider - An optician, optometrist or ophthalmologist who is able to provide services and/or materials.
Scratch-Resistant Coating - A coating that helps reduce scratches on lenses.
Single Vision Lenses - Lenses for those who only need correction for one field of vision: either far away or up close.
Tint - A lens add-on that reduces the amount of light that enters the eyes. A tint is sometimes recommended by a doctor.
Trifocal Lenses - Lenses for those who need correction for three fields of vision: up close, intermediate, and far away.
UV Coating - A common lens coating that protects eyes from harmful ultraviolet light.