Delta Dental of Arizona

Current Location: Delta Dental of Arizona >Brokers >Individual Vision Plans

September 9, 2010

Individual Vision Plans

Delta Dental of Arizona is now offering a vision benefit for our Individual & Family Plan members. Protect your vision with DeltaVision and you can save on your eye care and eyewear needs.

Must be enrolled on a Delta Dental of Arizona Individual Plan to be eligible for Vision Coverage
Individual Vision coverage must be paired with Individual Dental Coverage & Family Vision must be paired with Delta Dental Family Coverage.
3 month premium required to enroll

Monthly Vision Premium Rates (DDAZ Individual Dental plan enrollment required)	Gold Vision Plan
DeltaVision Individual	$4.57
DeltaVision Individual & Family	$12.57

Vision Care Services	Member Cost	Out-Of-Network

Exam with Dilation as necessary	$10.00 copay	Up to $30 allowance

Frames

Any Frame available at provider location	$0 copay; $120 allowance 20% off balance over $120	Up to $60 allowance

Standard Plastic Lenses

Single Vision	$10 copay	$25

Bifocal	$10 copay	$40

Trifocal	$10 copay	$55

Standard Progressive **	$70	$40

Premium Progressive **	$70, 80% of charge less $110 allowance	$40

Lens Options

Standard Plastic Scratch Coating	$0	$5

Contact Lenses (discount applies to materials only)

Conventional	$0 copay; $80 allowance, 15% off balance over $80	Up to $64

Disposable	$0 copay; $80 allowance, plus balance over $80	Up to $64

Medically Necessary	$0 copay, Paid-In-Full	Up to $200

Frequency

Examination	Once every 12 months

Frame	Once every 12 months

Lenses or Contact Lenses	Once every 12 months

** Standard/Premium Progressive lenses not covered

Additional Benefit Information

Additional Discounts	In-Network member Discount

Exam Options
Standard Contact Lens Fit and Follow up	Up to $40
Premium contact Lens Fit and Follow Up	10% off Retail
Lens Options
UV Treatment	$12
Tint(Solid and Gradient)	$12
Standard Polycarbonate	$35
Standard Anti-Reflective Coating	$40
Other Add-Ons and Services	30% off Retail Price



Member receives a 30% discount on items not covered by the plan at network Providers, which cannot be combined with any other discounts or promotional offers. Discount does not apply to EyeMed provider's professional services, or contact lenses. Members also receive 15% off retail price or 5% off promotional price for Lasik or PRK from the US Laser Network, owned and operated by LCA Vision. Members also receive a 40% discount off complete pair eyeglass purchases and a 15% discount off conventional contact lenses once the funded benefit has been used.

DeltaVision® is offered through Canyon Insurance Services, Inc., a wholly owned subsidiary of Delta Dental of Arizona, in partnership with EyeMed Vision Care, LLC.