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
Network | Insight |
Frame/Contact Allowance | $150/$150 |
Copay (exams/standard plastic lenses) | $10/$10 |
Frequency (exams/lenses or contacts/frames) Based on calendar year | 12 months/12 months/24 months |
Dependent Age Limit | To age 26 |
Benefit Details | Network Benefit | Out-of-Network Reimbursement |
Comprehensive Glasses Exam | Member pays $10, plan pays balance | $35 |
Retinal Imaging | Member pays up to $39 | None |
Standard Contact Lens* Fit and Follow-Up | Member pays up to $40 | None |
Premium Contact Lens** Fit and Follow-Up | 10% discount off retail | None |
Frames (any available frame at provider location) | $150 allowance, then 20% off balance | $75 |
Laser Vision Correction (Lasik or PRK) | 15% off retail price or 5% off | None |
Benefit Details (continued) | Network Benefit | Out-of-Network |
Contact Lenses – In lieu of glasses (Contact lens allowance covers materials only) | ||
Conventional | $150 allowance, then 15% off balance | $120 |
Disposable | $150 allowance | $120 |
Medically Necessary*** | Paid in full | $200 |
Premium Progressive Lens | ||
Tier 1 | $95 copay | $60 |
Tier 2 | $105 copay | $60 |
Tier 3 | $120 copay | $60 |
Tier 4 | $75 copay, 80% of charge less $120 | $60 |
Premium Anti-Reflective Coating | ||
Tier 1 | $57 | None |
Tier 2 | $68 | None |
Tier 3 | 80% of charge | None |
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!
