Vision Benefits

Name: Heartland Center for Behavioral Change
Address: United States

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

	In-Network	Out-of-Network
Routine Eye Exam With Dilation as Necessary Retinal Imaging	$10 Copay Up to $39	Up to $40 Not Covered
Frames	$0 Copay 20% Off Balance Over $130 allowance	Up to $52
Lenses Single Vision Lined Bifocal Lined Trifocal Lenticular	$10 Copay	Up to $20 Up to $40 Up to $60 Up to $100
Contact Lenses (in lieu of Glasses Conventional Disposable Medically Necessary	$10 Copay; 15% off balance over $130 allowance $10 Copay+balance over $130 allowance $10 Copay; $250 allowance	Up to $78 Up to $78 Up to $250

Frequency of Services
Exam	Once every 12 months
Frames	Once every 24 months
Lenses and Contacts	Once every 12 months

	Semi-Monthly Deduction	Monthly Employee Deduction
Employee	$3.05	$6.61
Employee + Spouse	$5.71	$12.38
Employee + Child(ren)	$6.48	$14.04
Family	$9.49	$20.56

Downloads

Summary of Benefits

Provided By

Delta Dental

Provider Website

https://deltadentalmo.com

Customer Service

877.226.1412

Resources

Frequently Asked Questions