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    Dental and Vision
     
    Dental Insurance
     
    Dental coverage is provided through Delta Dental of Virginia.  The LCPS plan is a PPO and is part of the Premier and Preferred networks.  Coverage is provided for both in-network and out-of-network services and are based on a Plan Year of January through December.
     
     
    In-Network
     
    Preventitive Services:  Covered 100% (2 visits per year)
    Basic Services: Covered at 80% after a $50.00 deductible ($150.00 family)
    Major Services: Covered at 80% after a $50.00 deductible ($150.00 family)
     
    Out-of-Network
     
    Preventitive Services:  Covered 80% of Usual and Customary Rates (UCR) (2 visits per year)
    Basic Services: Covered at 60% of UCR after a $50.00 deductible ($150.00 family)
    Major Services: Covered at 50% of UCR after a $50.00 deductible ($150.00 family)
     
    Benefit Maximums
     
    Annual benefit maximum for Basic and Major services is $1,250.00 per enrollee per contract year.  The benefit maximum is cumulative between in and out-of-network benefits.
     
    Orthodontics are covered at 50% of UCR up to a lifetime maximum of $1000 per person for both in-network and out-of network. 
     
    Healthy Smile, Healthy You Program
     
    If you are pregnant, have diabetes, have certain high-risk cardiac conditions or are receiving chemo or radiation for cancer, you are eligible for an extra cleaning and exam beyond our plan's normal annual limit.  Click here for more information on the program and find the Healthy Smile, Healthy You enrollment form under Infomation, Forms and Resources on the right side of this page.  
     
     

    Vision Insurance 

     
    Vision coverage is provided through Davis Vision for routine eye exams, glasses or contact lenses.
     

     

    In-Network
     
    Eye Exam: $15 co-pay
    Lenses: $15 co-pay (Additional fees will apply for extra coatings and specialty lenses)
    Frames: A credit of $110 is provided towards the purchase of frames ($160 credit at Visionworks)
    Contact Lenses: $100 allowance towards a year supply of contact lenses in lieu of eye glass lenses 
     

    Out-of-Network

     
    Eye Exam: Reimbursed up to $35
    Lenses: Reimbursed $25 and up for lenses based on type of lens purchased
    Frames: Reimbursed up to $35 
    Contact Lenses: Reimbursed up to $95 
      

     

     

     

    Information, Forms and Resources 
     
     
     
     
     
     
     
     
     
     
     
     

     Delta Dental Contact Information
     
    Member Services:
    1-800-237-6060 
     
    Website: 
     
     
    Claims Address: 
    Delta Dental of Virginia 
    4818 Starkey Rd.
    Roanoke, VA 24014
      
     
    Prevention First
    The costs for preventive care are excluded from your annual benefits maximum. Click here for more informaiton on the Prevention First benefit. 
     
    Extra Cleanings?
    Click here for more information and for the Healthy Smile, Healthy You form.
     
      

    Davis Vision Contact Information
     
    Member Services:
    1-888-235-3130 
     
    Website:
    Client Control Code: 7025 
     
    Claims Address:
    Vision Care Processing Unit 
    PO Box 1525
    Latham, NY 12110 
     
     
Last Modified on Wednesday at 2:23 PM