If you are a medical plan participant, you are also eligible for an annual preventive vision exam under your medical plan. As long as you use your medical plan provider’s network and the provider bills the vision exam as a routine exam, the exam will be covered in full.
If you are interested in additional vision coverage or waive our medical insurance, the DeltaVision Preferred plan may be a good fit for you. DeltaVision offers a voluntary vision plan administered by EyeMed Vision Care, one of the nation’s leading vision providers. This plan includes coverage for important preventive eye care, eyewear and discounts on laser vision correction. Since this is a voluntary plan, the total premium cost is paid by you on a pre-tax basis.
Access a list of providers by visiting Delta Vision and click the “Provider Search” tab in the drop-down box to identify providers in the Access provider network, or call (866) 723-0513.
Temporary ID Card
Vision Benefit Summary
| PLAN FEATURE | FREQUENCY | IN-NETWORK
(EYEMED PROVIDER) | OUT-OF-NETWORK
(NON-EYEMED PROVIDER) |
| Eye Exam | Once every 12 months
(to the day) | Member pays $0 | $35 allowance,
then member pays balance |
| Eyeglasses – Frames | Frames covered every 24 months | $130 allowance, then 20% off balance | $65 allowance,
then member pays balance
|
| Eyeglasses – Standard Plastic Lenses* | Lenses covered every 12 months** | Member pays $0 | Single vision - $25 allowance,
Bifocal - $40 allowance, or
Trifocal - $55 allowance,
then member pays balance
|
| Contact Lenses* | Lenses covered every 12 months** | $150 allowance,
then 15% off balance
| $96 allowance,
then member pays balance |
Contact Lens Fit and
Follow-up
(Standard contact lenses) | | Member pays $0 | $40 allowance,
then member pays balance
|
| Corrective Surgery | | Member pays 85% of retail or 95% of promotional cost | Member pays 100%
(no discounts)
|
*Basic Lenses paid in full by the plan if purchased at an in-network provider. Additional charges will apply for add-ons such as anti-reflective coating, progressive lenses and scratch resistant coatings.
**Lenses or contact lenses are covered every 12 months, not both.
Vision Summary Plan Description (SPD)
DeltaVision Handbook
For additional information, click here or please contact HealthAdvocate through email [email protected] or by phone (866) 799-2728.
