Vision Insurance Definitions You Need to Know

Without knowing the meaning of the different terms found in health insurance terminology, reading the definitions for vision care insurance can be confusing. In this article we will explain some of the terms found in vision and eye care pamphlets that you need to know.

The calendar year always pertains to a 12 month cycle that begins January 1 and ends December 31.
Most plans have placed a set dollar limit which is defined as the “Capitation” regardless of how much or how little you use of the predetermined amount. This is what the provider pays for services rendered in a single calendar year.

The Carrier is defined as the HMO or the insurance company who offers the health plan.

Co-insurance is the amount “you” the insured pays after your deductible has been met. Usually your co-insurance is a percentage of that deduction. For example, 80 percent of the fee for medical services is paid for by your employer or insurance company, and the remaining 20 percent is your responsibility. Most plans have yearly deductible amounts as terms of the coverage.

A “Defined Contribution Plan” is when the employee contributes a certain portion of money each calendar year into his own personal employee account which is set aside to pay for medical expenses.
If an insurance company decides not to pay for medical care requested from the provider this is a “Denial (of the claim.)

Spouses and/or children of an insured person are defined as “Dependents”.

Any eye care services that are not covered under the vision called “Exclusions”.

FSH is an abbreviation for “flexible spending account” with provisions allowing an employee to use pre-tax dollars to purchase benefits which may not be covered in their plan such as vision or eye care benefits.
Generic Drugs are medications that are almost identical to brand name products. Once the patent on brand name medications has expired the generic makers of the same drug can market their products more competitively. Typically the generic drug is much cheaper and your health care provider will recommend you choose the generic over the name brand.

Vision insurance which is purchased by organizations like unions or businesses is known as “Group Vision Insurance” providing coverage for all individuals employed.

“HIPPA” is a federal law implemented in 1996, “The Health Insurance Portability and Accountability Act”, this law protects the privacy of medical records and places limits on sharing personal identifiable information. HIPPA allows you the insured to qualify for immediate and comparable coverage should there be a change in your employment status. Your eye doctor will provide you with documentation which should be signed to verify you are covered by the HIPAA guidelines.

HMO stands for “Health Maintenance Organization”. They provide pre-paid insurance plans where an individual or employee pays a fixed monthly fee for all services rendered instead of separately paying for each visit or service. Regardless of the level of service the monthly capitation always stays the same.
Health Savings Account (HSA) is a savings account set up in advance which is used to pay for health care and eye care with pre-tax income. You must have a high-deductible health insurance policy in order to open a HSA type account.

Individual Vision Insurance Eye Care Coverage is coverage sold to an individual instead of a group. Generally your membership fee will be a little higher.

IPA’s are an “Independent Practice Association” consisting of eye and/or health care providers. They are similar to HMO’s with the exception that you are seen in a private doctor’s office instead of an HMO facility.
Managed Vision Care is a management company that oversees the quality and cost of eye care services. Typically it is provided by an HMO or a preferred provider organization which includes independent eye doctors.

Membership Fees are your annual fees which keep your vision plan current.

Networks include individuals consisting of hospitals, doctors and health care providers agreeing to provide services for less than the usual fee.

Out Of Network In Vision Care are ophthalmologists and optometrists that do not provide for eye care services at discounted rates.

Outpatient Services are services provided that do not include overnight stays in hospital or medical facilities which may include LASIK and cataract surgery. Be sure to read your coverage carefully as many insurance companies will not cover the cost of certain tests or procedures unless performed on an outpatient basis.

PPOs are “Preferred Provider Organizations. These health care providers are established by an insurance company that provides health care for policyholders at discounted rates. If you choose a PPO your coverage will be at a higher cost.

Premiums are the annual fee you pay each year to keep your coverage current.

Primary Care Provider is the ophthalmologist or optometrist that monitors your individual eye care. They perform routine annual examinations and refer you to specialized doctors for additional care.

The Provider is the health care physician which provides services to the patient. Providers generally accept most plans. Upon your first visit they will review your plan to determine if the eye care insurance presented is acceptable.

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Individual Vision Insurance – What Are the Various Ways it Can Benefit You?

You may fall into either of the two categories: you have perfect eyesight and will not need prescription glasses or treatment/surgery for vision in the next several years. Or you either currently have poor eyesight or may develop some vision problems in the near future. Unfortunately, people belonging to the former category are almost impossible to find these days, what with the increased strain put on the eyes by our modern lifestyle where most of our time is spent before TV and computer screens. If you belong to the latter category, you would definitely benefit a great deal by investing in individual vision insurance.

What exactly is individual vision insurance? To explain in simple terms, it is an added benefit that can be purchased in addition to your regular health insurance. It costs only a few dollars each month (around $15-20 for most providers) and covers a variety of benefits. These range from providing coverage for visits to an eye doctor, partial coverage for eye glasses/lenses, and even surgical procedures such as LASIK.

Anybody who has suffered from poor vision knows how expensive the above mentioned treatment options can be. A single visit to the optician for a routine pair of glasses can set you back by a couple of hundred dollars. For most people, this is prohibitively out of reach. Fortunately, by paying your insurance company just a few dollars extra each month, you can cut costs dramatically on these services.

In most cases, your individual vision insurance provider will be separate from your primary insurance provider, although you should be able to find a plan that offers both. One of the biggest vision insurance providers in the United States is VSP and it works in partnerships with various insurance providers to avail you of its services. If you get your insurance through your employer, you should be able to obtain vision insurance as an added benefit without any trouble, though you may have to pay for it through your own pocket (which is a minor expense compared to the possible benefits).

For people who have poor vision, or may suffer from it in the near future, individual vision insur

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