Vision Benefits

Vision insurance offers coverage for the routine care of your eyes and may provide coverage for eyeglasses and contact lenses. Your plan will pay for these services based upon the schedule below. Be sure to check your plan certificate for details.

Keep in mind that your costs will generally be lower if you choose an in-network eye-doctor. To find an in-network eye-doctor, please visit deltadentalmo.com.

	In-Network	Out-of-Network	Frequency
Routine Eye Exam	$10 Copay	Up to $40	Once every calendar year
Frames	$125 Allowance + 20% off remaining balance	Up to $40	Once every other calendar year
Contact Lenses
Medically Necessary	$25 Copay; $250 Allowance	Up to $250	Once every calendar year
Elective	$25 Copay $125 Allowance + 15% off remaining balance	Up to $60	Once every calendar year
Standard Plastic Lenses
Single Vision	$25 Copay	Up to $20	Once every calendar year
Bifocal	$25 Copay	Up to $40	Once every calendar year
Trifocal	$25 Copay	Up to $60	Once every calendar year
Lenticular	$25 Copay	Up to $100	Once every calendar year

	Per Pay Period Cost (26)
Employee	$3.38
Employee + Spouse	$6.76
Employee + Child(ren)	$6.42
Family	$11.04

Downloads

Summary of Benefits

Provided By

Delta Dental of Missouri

Provider Website

http://deltadentalmo.com/

Customer Service

800.335.8266