Here are the important terms to know as you research your options for vision coverage.
At the end of the year, with open enrollment just around the corner, it’s easy to feel a little overwhelmed. Insurance coverage has a host of specialized terms that can make it hard to feel confident about what you’re signing up for or what benefits you’ll receive.
At Heritage, we think it’s crucial for you to be aware of the benefits you’re entitled to, so that you can take full advantage of them for your and your family’s health. To that end, we’ve created a short guide to some of the terms—both general insurance terms, and vision care-specific terms—you might see as you go through the open enrollment process.
General insurance terms
The insurance industry is a lot to explain in a single blog post, and we know better than to try. But familiarizing yourself with the basics can help you make your coverage choices with confidence. Here are a few terms to know as you make your selections for 2024.
- Open enrollment: The time of year in which you can enroll in healthcare or make changes to your coverage, without the requirement of a qualifying life event (like marriage, the birth of a child, or sudden loss of coverage). Federal open enrollment typically takes place from November 1 to the following January 15, but employer-provided plans may have different open enrollment dates. Be sure to talk to your benefit manager about your company’s open enrollment dates so that you don’t miss your cutoff.
- Premium: The amount that you pay monthly for your health insurance coverage. You can think of it like a subscription fee. The amount of your premium is typically related to the level of coverage a plan offers, and also often has a relationship to the plan’s deductible.
- Deductible: The total amount of spending on healthcare that you are responsible for each year, before your insurance begins paying. The amount you’ve paid toward your deductible resets to zero at the beginning of each year.
Some health insurance plans may exchange a lower premium—your monthly cost—for a higher deductible, meaning that while you’ll pay less each month, you are responsible for more of your own costs before your insurance begins paying. These kinds of plans might be a cost-effective choice for people with no long-term or ongoing health concerns. Alternatively, a plan with a higher premium but a lower deductible means you pay more per month, but your insurance will begin covering costs sooner. If you have frequent or long-term healthcare needs, this type of plan may be better for you.
- Copay: An abbreviation of “copayment.” Even once you’ve met your health insurance deductible and insurance is covering the bulk of your medical costs, in many cases you’ll still need to cover a small, fixed amount. This amount is your
- Out-of-pocket maximum: This is the next threshold beyond your deductible—the maximum that your healthcare plan will require you to spend on covered medical expenses in a year. If you exceed this total, medical expenses covered under your insurance plan will be paid completely by your insurer.
- Provider network: The collection of healthcare providers—physicians, specialists, institutions, and other care professionals—whose services are covered by your insurance plan. In many cases, insurance companies purchase pre-assembled lists of providers. Heritage, however, is proud to say that we’ve built our provider network ourselves, by developing relationships with professionals and businesses we trust.
Vision insurance terms
Vision insurance isn’t a requirement under the Affordable Care Act, but you may see it as an option when making your insurance selections for 2024. Naturally, we’d recommend adding vision insurance, because taking care of your eyes is an important part of your overall health. In addition, your eyes can often show the first symptoms of larger, systemic health issues, which makes eye exams an important early checkpoint for catching these conditions. To top it all off, you never know when you or a family member might experience vision or eye health changes.
As you consider your options for vision coverage, here are some terms you may encounter.
Different levels of vision coverage may include a variety of types of corrective lenses, whether glasses or contacts. If you’re interested in specific options, like contacts or transition lenses, it helps to know whether your plan covers them.
- Polycarbonate (poly): the most durable material for eyeglass lenses. Poly lenses are also lighter and thinner than any other lens material, making them a great option for children’s glasses.
- Photochromic: Light-sensitive lenses which darken—like sunglasses—in bright sunlight.
- Progressive: Progressive lenses are an alternative to traditional bi- or trifocal lenses, which contain multiple prescription types for distant and close-up viewing. Rather than a sharp line where the prescription changes, progressive lenses have a gradient, making them less visually different from single vision “regular” glasses.
Your regular eye exam is a series of tests, generally non-invasive and pain-free, that measure the accuracy of your vision and overall eye health. An eye exam commonly includes the following tests:
- Eye muscle movement: The patient is asked to watch a moving target, such as a finger or a pen, while the doctor checks their eyes for alignment.
- Cover test: The doctor asks the patient to focus on a distant target while covering and uncovering each eye to check for eye movement.
- External exam and pupil reactions: The doctor observes how the patient’s pupils adjust to light and close objects and checks the whites of the eye and eyelid positioning.
- Visual acuity: The portion of an eye exam where patients are asked to cover one eye and read an eye chart until they can’t read the letters anymore.
- Refraction testing: The doctor asks the patient to look through a device called a phoropter, and then flips back and forth between lenses to refine the prescription.
- Slit lamp/Biomicroscope: The doctor uses this device to magnify and illuminate the front of the patient’s eye to check for signs of eye disease or other medical conditions.
- Retinal examination/Ophthalmoscopy: The doctor dilates the pupils to see the back of the patient’s eye, including the retina, retinal blood vessels, vitreous fluid, and the head of the optic nerve.
Your vision insurance coverage will typically include a standard eye exam each year, which we encourage our members to take advantage of. For specific information on what your plan covers, see your benefits administrator, or contact Heritage’s customer service.
There are several types of eye care professionals. Each type has a different area of focus, and can offer different kinds of care.
- Optometrist: Also called a Doctor of Optometry (O.D.), they diagnose and treat vision problems, eye diseases, and related conditions. They also prescribe eyeglasses, contact lenses, and medications to treat eye disorders, but do not perform surgery.
- Ophthalmologist: A physician who specializes in the medical and surgical care of the eyes and visual system and in the prevention of eye diseases and injury. An ophthalmologist can be a Medical Doctor (M.D.) or Doctor of Osteopathy (D.O.).
- Optician: They can fill a doctor’s eyewear prescription, fit and adjust eyeglasses, and in some states, fit and fill a prescription for contact lenses as well.
Don’t let open enrollment overwhelm you.
Open enrollment season is here, but don’t worry. With a little information, you can make the most of this opportunity to choose the right health care coverage for you and your family. And while you do, make sure to review your vision coverage options—your eyes are an integral part of your overall health, and deserve the best quality care.