Essential plan
In-network coverage
| Exam/Lens/Frame frequency (months) | 12/12/24 |
| Contacts frequency (in lieu of glasses) | 12 |
| Exam copay | $10 |
| Materials copay | $25 |
| Frame allowance | $130 $70 - Walmart/Sam's Club and Costco |
| Elective contact lens allowance | $130 |
| Necessary contact lenses | Covered in full after copay |
| Contact lens Fit/Eval copay | $60 |
| Both frames and contacts in the same year | No (allows contacts in lieu of frames) |
Out-of-network allowances
| Benefits | Member cost |
|---|---|
| Examination; up to: | $45 |
| Single vision lenses; up to: | $30 |
| Bifocal lenses; up to: | $50 |
| Trifocal lenses; up to: | $65 |
| Progressive lenses; up to: | $50 |
| Lenticular lenses; up to: | $100 |
| Frames; up to: | $70 |
| Elective contact lenses; up to: | $105 |
| Necessary contact lenses; up to: | $210 |
Lens enhancements1
| Benefits | Member cost |
|---|---|
| Anti-glare coating | $41 single $41 multifocal |
| Impact-resistant lenses (Adult) | $31 single $35 multifocal (covered for children) |
| Progressive lenses | Standard progressive lenses are covered |
| Light-reactive lenses | $75 single vision $75 multifocal |
| Scratch-resistant coating | $17 single vision $17 multifocal |
Additional savings
| Benefits | Plan details |
|---|---|
| Frames discount over allowance2 | An extra $20 allowance on featured designer brands for frames. 20% savings on any amount above the retail allowance. |
| Additional pair2 | 20% savings on unlimited additional pairs of prescription glasses and/or nonprescription sunglasses from any VSP provider within 12 months of exam. |
| LASIK2 | Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities. |
| Retinal Imaging2 | Routine retinal screening covered for a maximum fee of $39. |
| Lens coverage2 | Glass or plastic single vision, lined bifocal, lined trifocal, or lenticular lenses are covered in full.3 |
| Essential Medical Eye Care |
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| Low vision |
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| Eyeconic® 2 | Go to Eyeconic.com for an easy-to-use, convenient online eyewear option. |
| TruHearing® 4 | Save up to 60% on hearing aids and batteries. Visit TruHearing.com/VSP or call 877-396-7194 for more information. |
Disclaimers and Exclusions
Promotions and featured frame brands do not apply at Costco® Optical. Walmart/Sam's Club and Costco® Optical allowance of $80 is equivalent to the frame allowance at VSP doctor locations and participating retail chains.
1Prices shown reflect the standard plastic price for each respective category. Premium lens enhancement prices may vary. Prices are valid only through VSP Choice Network Providers and are subject to change without notice.
2Available In Network only.
3Covered in full materials and services are less any applicable copay. Based on applicable laws, benefits and savings may vary by location. Benefits may also vary at participating retail chains. Promotions like rebates are continually evaluated and subject to change without notice. In the state of Washington, VSP Vision Care, Inc., is the legal name of the corporation through which VSP does business.
The following items are excluded under this plan: plano lenses (lenses with refractive correction of less than +/- diopter), two pairs of glasses instead of bifocals; replacement of lenses, frames, or contacts; medical or surgical treatment; orthoptics; vision training or supplemental testing.
4VSP is providing information to its members, but does not offer or provide any discount hearing program. VSP makes no endorsement, representations or warranties regarding any products or services offered by TruHearing, a third-party vendor. TruHearing is not insurance and not subject to state insurance regulations. For additional information, please visit vsp.com/offers/special-offers/hearing-aids/truhearing. For questions, contact TruHearing directly. Not available directly from VSP in the states of Washington and California.
This overview contains a general description of your vision care program for your use as a convenient reference. Complete details of your program appear in the group contract between your plan sponsor and Delta Dental of Connecticut, Inc. which governs the benefits and operation of your program. The group contract would control if there should be any inconsistency or difference between its provisions and the information in this overview. Claims processing, claims services, and provider network administration for DeltaVision are provided under contract by VSP. VSP, Eyeconic, and eyeconic.com are registered trademarks of Vision Service Plan.
Delta Dental of Connecticut is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.
