Aetna Dental / VSP Vision
FOR EXAMPLE: IF YOU CHOOSE HUSBAND & WIFE FOR DENTAL, THEN YOU MUST ENROLL IN VISION AS HUSBAND & WIFE.
Dental is offered through Aetna Insurance. There is a choice of two plans, PPO where you have free choice as to dentist, and DMO (like HMO) where you must select from a list of participating providers. NOTE: There is no waiting period under this plan.
Orthodontic Services are EXCLUDED from the plan.
|Dental Summary (Voluntary)
Aetna Dual Option
|Preventive Services||80% Benefit||80% Benefit||100% Benefit|
|Basic Services||80% Benefit||80% Benefit||Scheduled|
|Major Services||50% Benefit||50% Benefit||Scheduled|
Rates Effective 1/1/2016 to 12/31/2016
|Dental Rates (Voluntary)
Aetna Dual Option
|Husband & Wife||$120.12||$42.45|
|Parent & Child(ren)||$113.94||$44.71|
VISION SERVICE PLAN (Vision)
The VSP Vision Plan utilizes participating and non-participating doctors. The Plan has a $10 copay and 100% reimbursement for most in-network services. There is an option to utilize non-network doctors, however reimbursement is based on a fee schedule.
||Once every 12 months|
|Lenses||Once every 24 months|
|Frame||Once every 24 months|
| Services from a
Provider (Note 1)
| Services from a
|Examination||Paid-in-Full||up to $45.00|
|Single Vision Lenses||Paid-in-Full||up to $45.00|
|Bifocal Lenses||Paid-in-Full||up to $65.00|
|Trifocal Lenses||Paid-in-Full||up to $85.00|
|Lenticular Lenses||Paid-in-Full||up to
|Frame||A wide selection of attractive frames are covered in full. (Note 2)||up to $47.00|
| Contact Lenses –
Instead of glasses (Note 3)
|Medically Necessary||Paid-in-Full||up to $210.00|
|Elective||up to $130.00||up to $105.00|
Professional services for severe visual problems not
corrected with regular lenses, including:
| Supplemental Testing
(includes evaluation, diagnosis and prescription of vision aids where
|Covered-in-Full||up to $125.00|
|75% of cost||75% of cost|
|Maximum allowable for all Low Vision benefits of
$1000.00 every two (2) years.
When an examination and/or materials are received from a VSP participating provider, the patient will have no out-of-pocket expense other than the copayment, unless optional lenses are selected. Optional items include, but are not limited to, oversize lenses (61mm or larger), coated lenses, np-line multifocal lenses, treatments for cosmetic reasons, or a frame that exceeds the plan allowance
VSP’s frame benefit fully covers over half of the 42,000 frames currently available. Due to this large selection and the fact that buying habits and tastes differ from one region to the next, frame inventories may vary from office to office. When deciding on a frame, members should ask their doctors which ones are covered in full.
When receiving services for elective contact lenses, the standard eye examination is covered in full. The stated allowance is provided toward the contact lense evaluation, fitting costs, and the lenses. Any costs exceeding this allowance are the patient’s responsibility.
MONTHLY PREMIUMS for VISION
|Employee & Spouse||$13.45|
|Parent & Child(ren)||$13.73|
Rates Effective 5/1/2014 to 4/30/16
Rate and Comparison charts on this website are provided for informational purposes ONLY and are not to be considered as binding. Not all areas or plans are listed. While every effort is made to maintain the accuracy of this information, you should contact The OSSA Group to confirm rates and coverages available in your area.
If you are a current Block Staffing employee and would like to receive an information pack outlining the specific plans and rates available to you, contact Joe Marini at The OSSA Group, or call 1–800–582–8203 and he will get one in the mail to you.