Notice
Change Healthcare announced a breach of HIPAA privacy and is reaching out to individuals whose personal information may have been compromised. Although this incident does not involve Delta Dental of New Jersey or Connecticut, Change Healthcare is a vendor we used and we are providing this information to help our members who might be affected.
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DeltaVision® plan comparison
| 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 |
| Contacts (in lieu of glasses) |
12 | 12 | 12 | 12 |
| In-network coverage | ||||
| Exam copay | $10 | $10 | $0 | $0 |
| Materials copay | $25 | $10 | $0 | $0 |
| Frame allowance | $130 - Includes Walmart & Sam's Club* $70 - Costco* frame allowance |
$150 - Includes Walmart/Sam's Club* $80 - Costco* frame allowance |
$175 - Includes Walmart/Sam's Club* $95 - Costco* frame allowance |
$200 - Includes Walmart/Sam's Club* $110 - 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 |
Lens Enhancements1
| Benefits | Costs your plan covers |
|---|---|
| Anti-glare Coating | $41 Single $41 multifocal |
| Impact-resistant Lenses | $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 |
Out-of-Network Allowances (in addition to in-network copays)
| Benefits | Covered up to |
|---|---|
| Examination | $45 |
| Single Vision Lenses | $30 |
| Bifocal Lenses | $50 |
| Trifocal Lenses | $65 |
| Progressive Lenses | $50 |
| Lenticular Lenses | $100 |
| Frame | $70 |
| Elective Contact Lenses | $105 |
| Necessary Contact Lenses | $210 |
Additional Savings
| Benefits | Plan Details |
|---|---|
| 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 screening2 | 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 |
| Essential Medical Eye Care |
|
| Low Vision |
|
| 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 other participating retail chains.
*In-network status of the optometrist performing the exam may vary at participating retail chains. Please contact VSP and/or the optometrist at the retail location to verify network participation status before receiving services.
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 service, 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 New Jersey 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.
