Vision: Must be on RCPS Medical plan
with same coverage level as the Medical Plan
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Plan Features
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In-Network
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Out-of-Network
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Limitations
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|
Basic
Vision:
Yearly Eye Exam (no cost, in network)
|
100%
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Reimbursement:
Up to $40
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Exam
every 12 months. Provider must be informed that this is separate from your
medical plan and is offered by UnitedHealthcare Vision
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|
Buy-up
Option with selected vendors* Materials Copay
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$10*
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$10*
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Copay
due if member receives glasses/lenses/frames
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Lenses:
- Single vision
- Lined bifocal
- Lined trifocal
- Lenticular
- Polycarbonate
Lenses (Multi-focal)*
- Polycarbonate Lenses (Single Vision)*
|
|
- Up to $40
- Up to $60
- Up to $80
- Up to $80
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Every
12 months
|
|
Frames:
|
|
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Every
24 months
|
|
Elective contact lenses:
- “Covered in
full” selection
- All other
contacts
|
|
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In
lieu of glasses, every 12 months, limit 4 boxes
|
|
* (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: Dental PPO Plus Premier Plan
|
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%
|
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*Refer to Delta Dental
Benefit Description for coverage details
available on the RCPS website, Intranet, Human Resources page.)
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