Illinois Statutes Chapter 215. Insurance § 161/5. Definitions

§ 5. Definitions. As used in this Act:

“Covered materials” means materials for which reimbursement from the vision care plan is provided to an eye care provider by an enrollee's plan contract or for which a reimbursement would be available but for the application of the enrollee's contractual limitation of deductibles, copayments, or coinsurance. “Covered materials” includes lens treatment or coatings added to a spectacle lens if the base spectacle lens is a covered material.

“Covered services” means services for which reimbursement from the vision care plan is provided to an eye care provider by an enrollee's plan contract or for which a reimbursement would be available but for the application of the enrollee's contractual plan limitation of deductibles, copayments, or coinsurance regardless of how the benefits are listed in an enrollee's benefit plan's definition of benefits.

“Enrollee” means any individual enrolled in a vision care plan provided by a group, employer, or other entity that purchases or supplies coverage for a vision care plan.

“Eye care provider” means a doctor of optometry licensed pursuant to the Illinois Optometric Practice Act of 1987 or a physician licensed to practice medicine in all of its branches pursuant to the Medical Practice Act of 1987.

“Materials” means ophthalmic devices, including, but not limited to:

“Services” means the professional work performed by an eye care provider.

“Subcontractor” means any company, group, or third-party entity, including agents, servants, partially-owned or wholly-owned subsidiaries and controlled organizations, that the vision care plan contracts with to supply services or materials for an eye care provider or enrollee to fulfill the benefit plan of a vision care plan.

“Vision care organization” means an entity formed under the laws of this State or another state that issues a vision care plan.

“Vision care plan” means a plan that creates, promotes, sells, provides, advertises, or administers an integrated or stand-alone plan that provides coverage for covered services and covered materials.