Eye Exam Glossary

Here you'll find definitions of terms used when preparing for an eye exam.

Benefits - Specific dollar amounts reimbursed or specific discounts for each covered product or service.

Claim - A request for payment of benefits.

Copay - A specified dollar amount a member must pay out-of-pocket for a specified service at the time of service.

Cornea - The transparent, rounded tissue covering the front of the eye and serving as the first focusing mechanism of light entering the eye.

Dependent - A member's spouse and/or unmarried child who meets the dependent criteria stipulated by your employer/plan sponsor.

Dispensary - A provider location that can order prescription eyeglasses. Dispensaries may have on-site fabrication facilities or may send orders to off-site laboratories.

Eligibility - Entitlement to benefits of the plan within the specified dates defined in the benefit.

In-Network Providers - 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. Our network includes credentialed optometrists, ophthalmologists and opticians who can provide services and/or dispense materials covered under the plan.

Iris - An opaque portion surrounding the pupil and forming the colored portion of the eye.

LASIK (Laser Assisted In Situ Keratomileusis) - A type of laser eye procedure used to treat various refractive or focusing errors of the eye.  LASIK creates a flap that is created to expose inner corneal tissue for reshaping, thereby eliminating (or reducing) the corneal refractive error and significantly changing the requirement for corrective eyewear. The procedure is relatively painless with a rapid healing process.

Lens - A crystalline, biconvex tissue within the eye that focuses light rays upon the retina; this is the structure where cataracts may form.

Macula - The area of the retina responsible for clear, detailed central vision.

Ophthalmologist - A physician who specializes in eye surgery. Ophthalmologists also may diagnose and write prescriptions for eye diseases and disorders. Members can obtain an eye exam from an ophthalmologist at no additional charge.

Optic Nerve - The nerve that carries visual impulses from the retina directly to the brain.

Optician - A professional who is trained in the fit and usage of eyewear.

Optometrist - Primary health care providers who examine, diagnose, treat and manage diseases and disorders of the visual system, the eye and associated structures as well as diagnose related systemic conditions. They prescribe eyeglasses and contact lenses, low vision aids, vision therapy and medicines to treat eye diseases.

Out-of-Network (OON) Provider - A Professional Provider who is not in the network of approved/credentialed professionals and providers. Members who obtain out-of-network care without permission from the plan may have to pay for all or most of the care or materials out-of-pocket.

PRK (Photo-Refractive Keratectomy) - A type of laser eye procedure used to treat various refractive or focusing errors of the eye.  PRK reshapes tissue on the surface of the cornea, thereby eliminating (or reducing) the corneal refractive error and significantly changing the requirement for corrective eyewear. The procedure, although less surgically invasive, generally requires a longer healing process than LASIK.

Panel - The collection of eye care professionals who have contracted with us to provide services to covered members.

Patient Allowance - A fixed amount of dollars that may be applied toward the payment for a professional service and/or material as specified by the benefit.

Provider - An optician, optometrist or ophthalmologist who is able to provide services or materials to a member with coverage.

Pupil - The center of the eye that closes and opens to allow light to properly reach the rest of the eye.

Retina - The nerve fiber layer or inner surface of the eyeball on which images are projected and delivered to the optic nerve as impulses for transmission directly to the brain.

Sclera - The dense fibrous opaque white outer coat enclosing the eyeball except the part covered by the cornea.

Vitreous Humor - The clear colorless transparent gel that fills the eyeball behind the lens and in front of the retina.

 

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