Underwriting guidelines and plan provisions

Our DeltaVision plans are sold in combination with Delta Dental plans. The group must meet the eligible industry requirements set under our Small Group Dental plans in order to qualify for DeltaVision coverage.

1. Group Size: 2-9 enrolled/10-50 enrolled.
2. Eligible industries: Our vision plans are sold in combination with our Dental plans. The group must meet the eligible industries requirements set under our Small Group Dental plans in order to qualify for DeltaVision coverage. Please see Eligible Industries page in our Small Group Dental Brochure for a complete list of eligible/ineligible industries.  
3. Eligible employees: Full-time, permanent employees. Contract employees (From 1099 workers) are not eligible. Employer must submit documentation to verify employer/employee relationship. A group of two cannot be comprised of a dependent relationship (e.g., husband and wife).
4. Eligible dependents: Spouse (or domestic partner, if offered by group) and dependent children up to age 27. Dependents in military service are not eligible.
5. Eligible retirees: Retiree coverage is available in an active employee plan if there is no break in coverage and employee contribution is identical for both plans. Coverage must be available to all retirees.
6. Out-of-state enrollees: Eligible employees residing out-of-state may receive care from any licensed optometrist, regardless of location.
7. Employer contribution (used to determine participation requirements): Employee contribution must be paid through pre-tax payroll deductions.
   1. Employer-paid: Employer contributes at least 50% of the cost of the plan.
   2. Voluntary: Employer contributes less than 50% of the cost of the plan (employee may contribute up to 100% toward the cost of the plan).
8. Participation requirements (unless covered elsewhere): Minimum requirement for Vision plans: For groups 2-9, at least 2 must be enrolled. For groups 10-50, at least 25% of eligible employees must be enrolled.
9. Waiving coverage: Employees who contribute toward the cost of the premium for themselves and/or their dependents and employees/dependents with coverage elsewhere may have coverage waived.
10. Open enrollment: Employees who contribute toward the cost of coverage for themselves and/or their dependents, using pretax dollars, may enroll, terminate or change dependents status.
11. Termination: Vision coverage will end on the last day of the month when the primary enrollee is no longer eligible. Dependent coverage ends when a dependent is no longer eligible, or when the primary enrollee’s coverage ends.
12. Changing benefits: Groups can only change benefits at the policy anniversary (renewal).