VISION INSURANCE
Delta Dental of Wisconsin is proud to work with EyeMed® Vision Care as the network provider. The EyeMed Access and Select Networks are among the nation’s largest provider networks featuring:
〉 86,000+ EyeMed access points nationwide
〉 Popular retail chains: LensCrafters® Pearle Vision®, JCPenney Optical®, Sears Optical®, Target Optical®, Shopko® Optical Centers and others
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Exam: |
In-Network
$10 co-pay |
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Frequency Limits: |
Exam - Every 12 months Lens or Contacts - Every 12 months Frames - Every 24 months |
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Frame Allowance: |
$130 |
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Annual Contact Allowance: (Contact lens allowance covers materials only) |
$120 |
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Lenses (Standard plastic): |
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Single Vision |
$10 copay |
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Biofocal |
$10 copay |
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Trifocal |
$10 copay |
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Standard Progressive |
$75 copay |
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Lens Options: |
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UV Coating: |
$15 |
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Tint: |
$15 |
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Standard scratch resistance: |
$15 |
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Standard polycarbonate: |
$40 |
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Standard anti-reflective coating: |
$45 |
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Contact lenses in lieu of spectacles: (Contact lens allowance covers materials only) |
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Conventional |
$120 allowance, then 15% off balance |
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Disposable |
$120 allowance |
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Medically necessary |
Paid in full |
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Laser Vision Correction – Lasik or PRK |
Laser Vision Correction – Lasik or PRK |
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Additional in-network discounts: |
20% discount on items not covered by the plan at network providers, which may not be combined with any other discounts or promotional offers. |
|
Content |
Member also receive a 40% discount on complete eyeglass purchases and a 15% discount on conventional contact lenses once the funded benefit has been used. |
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Content |
Not all network providers offer Laser Vision correction services. Please contact your provider for availability of these services. |
| Exam: | In-Network $10 co-pay |
|---|---|
| Frequency Limits: | Exam - Every 12 months Lens or Contacts - Every 12 months Frames - Every 24 months |
| Frame Allowance: | $130 |
| Annual Contact Allowance: (Contact lens allowance covers materials only) | $120 |
| Lenses (Standard plastic): | |
| Single Vision | $10 copay |
| Biofocal | $10 copay |
| Trifocal | $10 copay |
| Standard Progressive | $75 copay |
| Lens Options: | |
| UV Coating: | $15 |
| Tint: | $15 |
| Standard scratch resistance: | $15 |
| Standard polycarbonate: | $40 |
| Standard anti-reflective coating: | $45 |
| Contact lenses in lieu of spectacles: (Contact lens allowance covers materials only) | |
| Conventional | $120 allowance, then 15% off balance |
| Disposable | $120 allowance |
| Medically necessary | Paid in full |
| Laser Vision Correction – Lasik or PRK | Laser Vision Correction – Lasik or PRK |
| Additional in-network discounts: | 20% discount on items not covered by the plan at network providers, which may not be combined with any other discounts or promotional offers. |
| Member also receive a 40% discount on complete eyeglass purchases and a 15% discount on conventional contact lenses once the funded benefit has been used. |
|
| Not all network providers offer Laser Vision correction services. Please contact your provider for availability of these services. |
To find an eye care provider go to www.deltadentalwi.com or call 844-848-7090
Your provider network will be listed on your ID card or customer service can assist in providing or replacing your ID card if needed.
Download the EyeMed mobile app to find eye care providers, check your benefits and much more!
