May 27, 2024
 

Frequently Asked Questions About DeltaVision®

Can I see one network provider for my exam and purchase my glasses through another network provider?
Yes. If you see two network providers, you simply make an appointment for the exam with the network provider of your choice, then make another appointment for materials with your other network provider of choice. The network providers will verify eligibility and plan coverage and to obtain authorization to provide services.

Note: If you want to have your prescription filled by a network provider, other than the one who performed the exam, please check with the doctor's office to ensure that it will fill another doctor's prescription.

Do I need a claim form if I see a network provider?
Claim forms are not required for services obtained at network providers. The provider will file all in-network claims.

My provider is not in the network. Do I need a claim form?
Non-network providers may require enrollees to pay for their services. Enrollees may then submit an out-of-network claim form and receipts to EyeMed for reimbursement. Click here for an out-of-network claim form or call 1-866-723-0513 to receive a printed form. Forms can also be emailed or faxed. Out-of network reimbursements are sent directly to the enrollee. Payment will include an explanation of benefits.

What if I have an emergency, such as lost, stolen or broken glasses?
If an emergency arises, call customer service at 1-866-723-0513 and explain the situation to the representative. Customer service will determine if you are eligible for coverage and will help you find a network provider.

If you elect to see an out-of-network doctor, pay for your procedures, fill out an out-of-network claim form, attach your itemized receipts, and submit them to EyeMed. Provided you are eligible for services, EyeMed will reimburse the claim according to DeltaVision's out-of-network doctor schedule of allowances.

What type of eyeglass lenses am I eligible for? What about progressive lenses?
To further meet the needs of its enrollees, DeltaVision allows enrollees to purchase the most popular lens options at controlled costs. The lens options below represent a substantial number of all lens add-ons purchased. Discuss the benefits and cost differences with your eye doctor.

Remember it is important to be a good consumer when purchasing any vision care products. Evaluate the importance of each option and its out-of-pocket cost. For example, some premium upgrade scratch resistant coats have a substantially greater cost than the standard scratch coating. Premium progressive lenses, because of the degree of cost difference can result in substantial out-of-pocket cost over what is covered by the plan.

Most plans will not provide for the entire purchase including options, and it is important to know what each option will cost. Your eye care professional will be able to help you understand the costs associated with the options you choose.

Lens Options

  • UV Coating
  • Tint (Solid & Gradient)
  • Standard Scratch-resistant
  • Standard Polycarbonate
  • Standard Progressive (Add-on to Bifocal)
  • Premium Progressive
  • Standard Anti-Reflective Coating
  • Other Add-ons and Services (20% discount off retail price)

Do I need a DeltaVision identification card?
Enrollees should present their ID card at the time of service to help expedite the process, but it is not required. A network provider needs the primary enrollee's name and date of birth to verify eligibility. Once eligibility is verified, enrollees may access their benefits and are only responsible for paying the designated plan copays and any other incurred charges. The provider will make arrangements for any eyewear to be fabricated and delivered.

What if I am dissatisfied with a network provider or the materials received through a network provider?
If a member has a complaint, he or she would initially contact customer service at 866-723-0513. Representatives are available seven days a week, are thoroughly trained in member resolution, and have the authority to deal directly with enrollees and providers to answer questions or resolve member complaints.

If my vision is corrected through laser vision correction, will I be able to disenroll from DeltaVision?
No. You must remain enrolled in the plan and pay premiums through the enrollment plan year, regardless of which covered vision benefits you use.

Is the DeltaVision frequency limitation based on date of service, or by calendar year?
It's based on date of service. So, for example, if you have a 12-month frequency limitation on frames and you purchase a pair of frames on April 15, 2010, you will not be eligible for benefits for another pair of frames until one year after that date.

Does DeltaVision provide an explanation of benefits after services are provided?
DeltaVision is provided by ProTec Insurance Company, a wholly-owned subsidiary of Delta Dental of Illinois, in association with EyeMed Vision Care networks. EyeMed will send an explanation of benefits.

Who is EyeMed?
DeltaVision is provided by ProTec Insurance Company, a wholly-owned subsidiary of Delta Dental of Illinois, in association with EyeMed Vision Care networks. EyeMed provides customer service for enrollees and Delta Dental of Illinois provides sales support and employer administrative services for DeltaVision benefit plans.

Why do I need an eye examination, especially if I haven't had a prescription change or I don't have a vision problem?

An eye examination means more than getting a prescription - it evaluates your eye health and is critical in the early detection of several vision and health-related conditions, including glaucoma, diabetes, cataracts, and hypertension. And, because early detection is the key for treatment, periodic eye examinations play a vital role in ensuring the health of your eyes.

Eye examinations are also important for the health and safety of children. The American Optometric Association recommends that children receive their first eye examination from an eyecare professional as early as six months of age. Afterwards, your provider will advise you when your child's next eye examination should be scheduled.

How long do I have to wait to get an appointment with my vision care provider?

You should be able to schedule a routine appointment (unless you are requesting a specific time or day of the week) within two to three weeks. Emergency visits should be scheduled within 24 hours.

Does my plan cover contact lenses?

Most DeltaVision benefit plans offer a contact lens allowance for fit, follow-up visits and materials that can be used in lieu of the eyeglass lens benefits.

What is the difference between "visually required" and "cosmetic" contact lenses?

"Visually required" contacts are a covered benefit for members that have one of four medical conditions:

1. Keratoconus where the patient is not correctable to 20/30 in either or both eyes using standard spectacle lenses.
2. High Ametropia exceeding -12 D or +9 D in spherical equivalent.
3. Anisometropia of 3 D or more.
4. Patients whose vision can be corrected two (2) lines of improvement on the visual acuity chart when compared to best corrected standard spectacle lenses.

Most standard contact lens purchases are classified as "cosmetic" or "elective" because the patient has a choice between wearing contacts or wearing glasses. Please note that the allowances for cosmetic or elective contact lenses are different from the allowance for visually required lenses. DeltaVision benefit plans offer generous allowances for both types of contact lenses.

Can I get glasses and contact lenses?

This will vary by your specific plan coverage. In most cases, contact lenses are in lieu of eyeglass lenses; you can get frames and contacts within the same benefit period. Please refer to your Certificate of Coverage for specific plan allowances.

Most DeltaVision benefit plans will also offer a 40% discount off complete pair eyeglass purchases and a 15% discount off conventional contact lenses in addition to the funded benefit. Please refer to your Certificate of Coverage to see if your plan offers this discount.

Additionally, your DeltaVision benefit plan provides a discount program at In-Network providers that offers 20% savings on items that are not covered by the plan. There are no claim forms to process and members have unlimited frequency on these purchases. This discount does not apply to professional services or contact lenses.

Does the plan limit the kind of eyeglass frames I can choose?

To ensure that you are totally satisfied with your benefit, the DeltaVision benefit plan allows members to choose from any available frame at a provider location. Members may apply their frame allowance to the frame of their choice, and will receive 20% off any remaining balance - equating to significant savings on high quality eyewear.

Most independent providers and all LensCrafters locations carry high quality designer frames by Luxottica, which may include: Anne Klein®, Brooks Brothers®, Persol®, Vogue® and many others.

What about extras, such as ultraviolet protection, anti-scratch coating and anti-reflective coatings? 

DeltaVision benefit plan members will receive discounts of up to 40 - 50% on the most popular lens options such as ultraviolet, scratch-resistant and anti-reflective coatings, tints, progressive lenses and polycarbonate lenses. Members receive a 20% discount on additional lens options.

Does your provider list include all types of eye care professionals?

EyeMed's network of vision care providers includes ophthalmologists (MD/DOs), optometrists (ODs) and opticians (RDOs). All providers are carefully credentialed before they are admitted into our network.

What is the difference between an ophthalmologist, optometrist and optician?

The EyeMed Vision Care network consists of:Ophthalmologists (MD or DO): Physicians who specialize in the treatment of diseases and disorders of the eye. Ophthalmologists are qualified to provide comprehensive eye examinations, treat and manage conditions and diseases of the human eye and visual system, and perform eye surgery. Optometrists (ODs): Doctors of Optometry are primary health care providers who examine, diagnose, treat and manage conditions and some diseases of the human eye and visual system. Optometrists are qualified to provide comprehensive eye examinations. Registered Dispensing Opticians (RDO): Opticians registered with the state Medical Board who sell, dispense and/or fabricate eyeglasses in accordance with the prescriptions of optometrists and ophthalmologists. Opticians are not qualified to provide eye examinations.

Can I apply for individual vision care insurance through DeltaVision?

DeltaVision only offers group insurance coverage through your employer or some other qualified organization. If your employer does not offer DeltaVision benefit insurance at this time, ask your Human Resources department to contact us at 1-800-335-8215 and we will be happy to provide them with information on DeltaVision.

DeltaVision is provided by ProTec Insurance Company, a wholly-owned subsidiary of Delta Dental of Illinois, in association with EyeMed Vision Care networks.