Members also receive a 40% discount off complete pair eyeglass purchases and a 15% discount off conventional contact lenses at in network providers once the funded benefit has been used.

 

After initial purchase, replacement contact lenses may be obtained via the Internet at substantial savings and mailed directly to the member. Details are available at www.deltadentalil.com/deltavision. The contact lens benefit allowance is not applicable to this
service.

 

LASIK or PRK: DeltaVision enrollees can receive a discount of 15% off retail price or 5% off promotional price from select providers. Please contact us at www.deltadentalil.com/deltavision or 866-723-0513 for a current list of LASIK/PRK providers.

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Network Information

You may choose to go to any licensed optometrist, ophthalmologist and/or dispensing optician whenever you need vision care. However, there may be significant cost advantages when you receive treatment from an innetwork provider.

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We offer two easy ways to locate an in-network provider 7 days a week, 24 hours a day. You can either:

• search our online Provider directory at www.deltadentalil.com/deltavision; or

• use the automated phone system by calling 1-866-723-0513

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Using Your Vision Program

1. Have your DeltaVision information card available when scheduling and visiting an in-network provider. An innetwork provider participates in the EyeMed Vision Care Provider network. It's very important that you know which network your benefit plan utilizes (your plan uses the Select network). You will only receive in-network benefits from Select network providers.. Please note: the network provider will need the primary enrollee's name and date of birth to verify eligibility.

2. Pay your copayment and any other charges not covered at the time of service. No paperwork is required. You continue to save on additional eyewear purchases any time you present your card to an in-network provider.

3. If you select a provider who is not in the network, you do not receive preferred pricing and you may be asked to provide full payment to your out-of-network provider at the time of service. To receive benefit reimbursement, submit a completed claim form (available on our website), along with itemized receipts from your provider and your prescription to:
   DeltaVision Claims Processing, c/o EyeMed Vision Care,P.O. Box 8504, Mason, OH 45040-7111

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Exclusions

In no event will coverage exceed the lesser of:

1. the actual cost of Covered Services or Materials or

2. the limits of the Policy, shown in the Schedule.
    

Lost or broken lenses, frames, glasses or contact lenses will not be replaced except in the next benefit period.
Benefits may not be combined with any discount, promotional offering or other group benefit programs.
Benefit allowances provide no remaining balance for future use within the same benefit period.
 

There is no coverage for professional services or materials connected with:

1. Orthoptic or vision training, sub-normal vision aids and any associated supplemental testing;

2. Aniseikonic lenses;

3. Medical and/or surgical treatment of the eye, eyes or supporting structures;

4. Corrective eyewear required by an employer as a condition of employment and safety eyewear unless specifically covered under this program;

5. Services provided as a result of any Workers' Compensation law;

6. Plano lenses (lenses that have no refractive power), non-prescription lenses and nonprescription sunglasses (except for 20% discount);

7. Two pair of glasses in lieu of bifocals.

 

The preceding information is a brief summary of ARCELOR MITTAL Complete Vision Program and the services it covers. If you have specific questions regarding benefit coverage, limitations or exclusions, contact our customer service department at 1-866-723-0513.

DeltaVision® is provided by ProTec Insurance Company, a wholly-owned subsidiary of Delta Dental of Illinois, in association with EyeMed Vision Care networks.
111 Shuman Blvd
Naperville, IL 60563
800-335-8215
www.deltadentalil.com/deltavision

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