Pennsylvania Statutes Title 40 P.S. Insurance § 991.2702. Definitions

The following words and phrases when used in this article shall have the meanings given to them in this section unless the context clearly indicates otherwise:

“Covered vision care.”Vision services and materials for which reimbursement is available under a health insurance policy, regardless of whether the reimbursement is contractually limited by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation or alternative benefit payment.

“Department.” The Insurance Department of the Commonwealth.

“Health insurance policy.”An individual or group health insurance policy, subscriber contract, certificate or plan issued by or through an insurer that provides covered vision care. The term does not include accident only, fixed indemnity, limited benefit, credit, dental, specified disease, Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) supplement, long-term care or disability income, workers' compensation or automobile medical payment insurance.

“Health insurer.”An entity licensed by the department with accident and health authority to issue a policy, subscriber contract, certificate or plan that provides medical or health care coverage and is offered or governed under any of the following:

“Insured.” An individual on whose behalf a health insurer is obligated to pay for vision care under a health insurance policy.

“Materials.” Ophthalmic devices, including, but not limited to, lenses, devices containing lenses, ophthalmic frames and other lens mounting apparatus, prisms, lens treatments and coating, contact lenses and prosthetic devices to correct, relieve or treat defects or abnormal conditions of the human eye or its adnexa associated with the delivery of vision care.

“Noncovered services.”Vision care that is not covered but for which a discount may be provided under the terms of a health insurance policy.

“Vision care.”Provision of eye care services, materials or both.

“Vision care provider.”A licensed doctor of optometry practicing under the authority of the act of June 6, 1980 (P.L. 197, No. 57),  4 known as the Optometric Practice and Licensure Act, or a licensed physician who has also completed a residency in ophthalmology.

“Vision care supplier.”A person or entity that creates, promotes, sells, provides, advertises or administers vision care supplies, including an optical laboratory. The term includes persons or entities affiliated with a health insurer.