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|DeltaVision - Essential||DeltaVision - Brilliance||DeltaVision - Premium||DeltaVision - Platinum|
|Exam/lens/frame frequency (months)||12/12/24||12/12/12||12/12/12||12/12/12|
(in lieu of glasses)
$70 Walmart/Sam’s Club and Costco frame allowance
$80 Walmart/Sam’s Club and Costco frame allowance
$95 Walmart/Sam’s Club and Costco frame allowance
$110 Walmart/Sam’s Club and Costco frame allowance
|Elective contact lens allowance||$130||$150||$175||$200|
|Necessary contact lenses||Covered in full after copay||Covered in full after copay||Covered in full||Covered in full|
|Contact lens fit/ eval copayment||$60||$60||$60||$60|
|Both frames and contacts in same year (in-network and out-of-network)||No; allows contacts in lieu of frames||No; allows contacts in lieu of frames||No; allows contacts in lieu of frames||Yes; allows both frames & contacts in the same year for each benefit|
|Benefits||Costs your plan covers|
|Anti-glare Coating||$41 Single
|Impact-resistant Lenses||$31 Single
$35 multifocal (covered for children)
|Progressive Lenses||Standard progressive lenses are covered|
|Light-reactive Lenses||$75 single vision
|Scratch-resistant Coating||$17 single vision
|Benefits||Covered up to|
|Single Vision Lenses||$30|
|Elective Contact Lenses||$105|
|Necessary Contact Lenses||$210|
|Frames discount over allowance2||There is 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 at no more than $39 copay.|
|Lens Coverage2||Glass or plastic single vision, lined bifocal, lined trifocal, or lenticular lenses are covered in full.3|
|VSP Diabetic Eyecare Plus ProgramSM||
|Eyeconic® 2||Visit 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. The relationship between VSP and TruHearing is that of independent contractors. VSP makes no endorsement, representations, or warranties regarding any products or services offered by TruHearing, a third party vendor. The vendor is solely responsible for the products or services offered by them. If you have any questions regarding the service offered here, you should contact the vendor directly.
TruHearing offers individuals the opportunity to purchase hearing aids at discounted prices, including individuals covered by self-funded health plans not subject to state insurance or health plan regulations. TruHearing is not the same as insurance and not subject to state insurance regulations. TruHearing provides discounts to certain health care groups for hearing aid sales and services. TruHearing provides fitting, programming and three adjustment visits at no cost; the member is obligated to pay for testing, and all post-fitting hearing care services, but will receive a discount from those health care providers who have contracted with TruHearing. 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 provider under contract by VSP. All other brands or marks are the property of their respective owners.