Vision: Must be on RCPS Medical plan with same coverage level as the Medical Plan

 

Plan Features

In-Network

Out-of-Network

Limitations

 

Basic Vision:

Yearly Eye Exam          (no cost, in network)

 

 

100%

 

Reimbursement:

Up to $40

Exam every 12 months. Provider must be informed that this is separate from your medical plan and is offered by UnitedHealthcare Vision

Buy-up Option with selected vendors* Materials Copay

 

$10*

 

$10*

Copay due if member receives glasses/lenses/frames

Lenses:

  • Single vision
  • Lined bifocal
  • Lined trifocal
  • Lenticular
  • Polycarbonate Lenses (Multi-focal)*
  • Polycarbonate Lenses (Single Vision)*

 

  • 100%
  • 100%
  • 100%
  • 100%

 

  • Up to $40
  • Up to $60
  • Up to $80
  • Up to $80

Every 12 months

Frames:

  • Wholesale
  • Retail

 

  • Up to $50
  • Up to $130

 

  • Up to $45
  • Up to $45

Every 24 months

Elective contact lenses:

  • “Covered in full” selection
  • All other contacts

 

 

  • 100%

 

  • Up to $105

 

 

  • Necessary-Up to $210

 

  • Elective-Up to $105

 

In lieu of glasses, every 12 months, limit 4 boxes

*New for 2017, lower cost Materials Copay and additional lens options. (Refer to UnitedHealthcare Vision Summary for coverage details, available on the RCPS website, Intranet, Human Resources page.)

 

 

         Dental*: Not required to be on RCPS Medical plan

 

 

Delta Dental Plan Features

Low Plan

High Plan

Annual Deductible

 

$25

(limit 3 per family per calendar year)

$0

 

Annual Maximum

$1,500

$2,000

Diagnostic & Preventive Services

100%

100%

Basic Dental Care

80%

80%

Other Basic Dental Care

 Benefit Waiting Period

12 months waiting period in Low Plan only

50%

80%

Major Dental Care

12 months waiting period in Low Plan only

50%

80%

Orthodontic Benefits

12 months waiting period

Orthodontic Lifetime Maximum=$1,500

N/A

50%

*Refer to Delta Dental Benefit Description for coverage details available on the RCPS website, Intranet, Human Resources page.)

 

40 Douglass Avenue NW, Roanoke, VA 24012 Phone 540-853-2502