DentalVision

• Administered by Delta Dental of Tennessee utilizing the PPO Standard network.
• Annual deductible is $50 per person or $150 for family.
• Graduated coverage based on how long policies are in force:
  
  • 0-12 months - $500 per person
  • 13-24 months - $1,000 per person
  • 25+ months - $1,500 per person
• First day coverage for routine exams and cleanings, not subject to the deductible
• Graduated coverage based on how long policies are in force

• Eye-care benefits administered by VSP
• Extensive network of independent optometrists and eyewear providers
• $15 copay for refractive exams
• $35 copay for frames (every 2 years), lenses (every year)
• $150 allowance for contacts per year

List of Dental's network of providers

WellVision exam

• Focuses on your eyes and overall wellness
• KidsCare: Children have two, fully covered WellVision Exams, if needed
• Every calendar year

Copay: $15

Prescription glasses

Copay: $35

Frame

• $150 allowance for a wide selection of frames
• $170 allowance for featured frame brands
• 20% savings on the amount over your allowance
• KidsCare: Frames for children are covered every calendar year
• Every other calendar year

Copay: Included in prescription glasses copay

Lenses

• Single vision, lined bifocal and lined trifocal lenses
• Polycarbonate lenses for dependent children
• KidsCare: Additional lenses for children are fully covered when needed. Minimum prescription change required
• Every calendar year

Copay: Included in prescription classes copay

Lens enhancements

• Standard progressive lenses
• Premium progressive lenses
• Custom progressive lenses
• Average savings of 20%-25% on other lens enhancements
• Every calendar year

Copay: Covered in full

$95 - $105

$150- $175

Contacts
(Instead of glasses)

• $150 allowance for contacts every calendar year

Copay: No copay

• Contact lens exam (fitting and evaluation) every calendar year

Copay: Up to $60

Glasses and sunglasses

• Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details
• 20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within 12 months of your last WellVision exam

Retinal screening

• No more than a $39 copay on routine retinal screening as an enhancement to a WellVision exam

Laser vision correction

• Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities

Exam up to $45

Frame up to $70

Single vision lenses up to $30

Lined bifocal lenses up to $50

Lined trifocal lenses up to $65

Progressive lenses up to $50

Contacts up to $105

DentalVision guarantees coverage from VSP network providers only. Coverage information is subject to change. In the event of a conflict between this information and Farm Bureau Health Plans’ contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location.

List of VSP's network of eye care providers