Delta Dental MAX + VSP Vision
Delta Dental PPO + Premier + VSP Choice
Delta Dental MAX + VSP Vision bundle — Dental: $1,500 in-net / $1,000 out annual max, $50/$150 deductible, 100%/80%/50% in & out of network. Vision (VSP Choice): $10 exam / $25 materials copay, $150 frame allowance every 24 months, $150 contact allowance, lenses every 12 months. No monthly admin fee.
Monthly premiums
- Member
- $101.50/mo
- Member & Children
- $176.50/mo
- Member & Spouse
- $184.50/mo
- Member & Family
- $269.50/mo
Benefits
Dental Annual Maximum
$1,500 in-net / $1,000 out
Delta Dental MAX • per person
Dental Deductible
$50 / $150
In or out of network • waived for preventive & diagnostic in-network
Preventive & Diagnostic
100% covered
In & out of network
Basic Services
80% covered
In & out of network
Major Services
50% covered
In & out of network
Orthodontia
Not covered
Out-of-Network Dental
Same coinsurance
100% / 80% / 50% out-of-network too
Eye Exam
$10 copay
VSP Choice network • every 12 months
Frames
$150 allowance
+ 20% off overage • every 24 months
Lenses
$25 copay
Single, bifocal, trifocal, lenticular • every 12 months
Contact Lenses
$150 allowance
+ 15% off fitting • medically necessary covered in full
Waiting Periods
None
Full coverage from effective date
Plan documents
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