23-99-1002. Definitions.

23-99-1002. Definitions. As used in this subchapter: (1) “Covered materials” means materials for which reimbursement from the insurer, vision care plan, or vision care discount plan is provided to a vision care provider by an individual's vision benefit plan or contract and that are reimbursable subject to a deductible, copayment, coinsurance, or other contractual limitations; (2) “Covered services” means services for which reimbursement from the insurer, vision care plan, or vision care discount plan is provided to a vision care provider by an individual's vision benefit plan or contract and that are reimbursable subject to a deductible, copayment, coinsurance, or other contractual limitations; (3) “Insurer” means an insurance company, a health maintenance organization, a hospital and medical service corporation, or a self-insured health plan for employees of a governmental entity; (4) “Materials” means ophthalmic devices, including without limitation: (A) Lenses; (B) Devices containing lenses; (C) Artificial intraocular lenses; (D) Ophthalmic frames; (E) Lens-mounting apparatus; (F) Prisms; (G) Spectacle or contact lens treatments and coatings; and (H) Prosthetic devices to correct, relieve, or treat defects or abnormal conditions of the human eye or its adnexa; (5) “Noncovered materials” means materials that are not covered by an insurer, a vision care plan, or a vision care discount plan; (6) “Noncovered services” means services that are not covered by an insurer, a vision care plan, or a vision care discount plan; (7) “Participating provider agreement” means an agreement between a vision care provider and an insurer that obligates a vision care provider to provide for compensation services and materials to an individual who is insured by the insurer; (8) “Services” means benefits or services provided by a vision care provider; (9) “Vision benefit plan or contract” means a plan, contract, or policy of insurance issued by an insurer that provides for vision care benefits or services; (10) “Vision care discount plan” means a separate plan to provide benefits or services under a rider to a health benefit plan or as a stand-alone agreement that is authorized by a vision care provider to provide discounts to individuals under the Primary Eye Care Provider Act, § 23-99-301 et seq.; (11) “Vision care plan” means an entity that provides health benefits and that creates, promotes, sells, provides, advertises, or administers an integrated or stand-alone vision benefit plan or contract; and (12) “Vision care provider” means an individual licensed as an optometrist under § 17-90-301 et seq., or a licensed osteopathic or medical physician licensed under § 17-91-101 et seq. or § 17-95-401 et seq., if the physician has also completed a residency in ophthalmology.