Dental and Vision Insurance - Industry Lingo

To make the right business purchases, you have to know the language. Here's a guide to insurance lingo.

Contract Doctor
A doctor that agrees to offer either discounted or free services (depending on the program) in order to participate in a contract program, like an HMO or PPO. They'll be reimbursed from the HMO or PPO.

Deductible
The fee a patient is responsible for before an insurance plan will cover any expenses. It can be a one-time charge, like a co-payment, or an annual charge. A deductible varies between insurance plans.

DHMO
Dental Health Maintenance Organization (DHMO) pay contracted dentists a fixed amount per enrolled family or individual, whether or not they use the dental services.

Employer/Employee Contribution
When an employer and employee both contribute money to the cost of premiums.

Employer Pays All
When an employer covers the full cost of premiums.

Fee Schedule
A list of the fees an eye doctor or dentist charges for certain procedures.

Glaucoma
A group of eye diseases that can lead to loss of vision or complete blindness.

Indemnity (Traditional)
An indemnity plan is a fully insured or self-insured plan where an assigned payment is provided for specific services, regardless of the actual charges made by the provider. Payment may be made to enrollees or, by assignment, directly to dentists.

Optometrist
A licensed doctor who can examine eyes for defects, diagnose problems, and prescribe glasses and treatment.

Ophthalmologist
A doctor that is licensed to perform eye surgery.

PPO
Preferred Provider Organization (PPO) programs are plans under which patients select a dentist from a network or list of providers who have agreed, by contract, to discount their fees.

Premium
The fee (monthly or annual) that an insurance firm charges in order to fund a dental or vision plan.

Reimbursement
The payment an insurance company will make to a patient if he or she has to pay up-front for a visit to a doctor. The patient usually files a claim in order to get reimbursed for the services that are covered by his or her insurance policy.

UCR (Usual, Customary, Reasonable)
A way to determine reimbursement levels for insurance (varies between insurance plans). It's the fee a doctor would usually charge (usual) combined with the fee the insurance agency sees fit based on a geographic area (customary) and a fee that would be rational based on the circumstances of the patient's situation (reasonable).

Voluntary
An employer will set up a plan with group rates, but the employee must cover the entire cost of the benefit.

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