Open Enrollment – Dental and Vision Plans - Human Resources at Ohio State

2021 Open Enrollment

November 1-15, 2020

Dental and Vision Plans

2021 Dental Plan

The Ohio State University Faculty and Staff Dental Plan provides both in-network and out-of-network benefit coverage for dental services. Delta Dental provides network coverage through two networks: Delta Dental PPO and Delta Dental Premier. Your out-of-pocket costs are less when you use a provider who participates in the Delta Dental PPO network.

Related Information

Effective Jan. 1 – Dec. 31, 2021

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Covered Services Delta Dental PPO Network (includes OSU Student Dental Clinic) Delta Dental Premier Network Out-of-Network
Annual Deductible $0 $50 per person $100 per person
Annual Maximum Benefit $1,500 per person1,3 $1,200 per person1,3 $1,200 per person1,3
Orthodontics has a separate lifetime maximum of $1,200
Preventive Services
(includes: cleanings, sealants, fluoride treatments, and space maintainers; bitewing, full-mouth or panoramic X-rays)
100% of allowed amount; no deductible; no balance billing2 100% of allowed amount; no deductible; no balance billing2 100% of allowed amount; no deductible; subject to balance billing
Emergency Palliative Treatments 100% of allowed amount; no deductible; no balance billing2 100% of allowed amount; no deductible; no balance billing2 100% of allowed amount; no deductible; subject to balance billing
Endodontics
(root canals)
80% of allowed amount, no deductible; no balance billing2 75% of allowed amount; after deductible; no balance billing2 70% of allowed amount; after deductible; subject to balance billing
Oral Examinations 100% of allowed amount; no deductible; no balance billing2 100% of allowed amount; no deductible; no balance billing2 100% of allowed amount; no deductible; subject to balance billing
Oral Surgery
(includes impacted tooth extraction)
80% of allowed amount, no deductible; no balance billing2 75% of allowed amount; after deductible; no balance billing2 70% of allowed amount; after deductible; subject to balance billing
Orthodontics 100% of allowed amount, up to $1,2001; no deductible 50% of allowed amount, up to $1,2001; no deductible 50% of allowed amount, up to $1,2001; no deductible
Coverage is only available for children up to age 19; $1,2001 lifetime maximum benefit. Benefits are pro-rated and paid over the course of the treatment.
Periodontics
(gum disease)
80% of allowed amount, no deductible; no balance billing2 75% of allowed amount; after deductible; no balance billing2 70% of allowed amount; after deductible; subject to balance billing
Prosthodontics
(includes dentures, fixed bridgework, and implants)
55% of allowed amount, no deductible; no balance billing2 50% of allowed amount; after deductible; no balance billing2 50% of allowed amount; after deductible; subject to balance billing
Restorative Services – Major
(includes cast restorations and crowns)
55% of allowed amount, no deductible; no balance billing2 50% of allowed amount; after deductible; no balance billing2 50% of allowed amount; after deductible; subject to balance billing
Restorative Services – Minor
(includes fillings, and repair of bridgework crowns, dentures, and onlays)
80% of allowed amount, no deductible; no balance billing2 75% of allowed amount; after deductible; no balance billing2 70% of allowed amount; after deductible; subject to balance billing
Temporomandibular Disorder (TMD) No coverage under the Dental Plan. Limited coverage is available under the Ohio State medical plans.
X-rays, All Others
(includes all diagnostic)
80% of allowed amount, no deductible; no balance billing 75% of allowed amount; after deductible; no balance billing 70% of allowed amount; after deductible; subject to balance billing
1 You are responsible for all costs over the maximums.
2 For any optional treatment (defined as a service that is more expensive than what is customarily provided or for which Delta Dental does not determine that a valid dental need is shown), you are responsible for the costs over the allowed amount, regardless of whether or not the service is provided in-network.
3 Some services are excluded from the annual maximum. A list of these services can be found in the 2021 Dental Plan Specific Plan Details (SPD) (coming soon).

NOTE: This Dental Plan Summary Chart should be used as a general guide only. Refer to the 2021 Dental Plan Specific Plan Details (SPD) (coming soon) for further information. If the information in the summary chart differs from the Specific Plan Details Document, the Specific Plan Details Document will govern.

2021 Vision Plan

The Ohio State University Faculty and Staff Vision Plan provides you and your covered dependents with benefit coverage for vision care services, such as eye exams, eyeglasses and contact lenses. You can choose between Basic and Premier Plan options, both of which use the Vision Service Plan (VSP) Choice Network but offer different levels of benefit coverage. For more information on the differences between these two plan options, read The Ohio State University Faculty and Staff Vision Plan Specific Plan Details (SPD) Document (coming soon).

Did you know your eyes can also reveal a lot about your overall wellness? An annual eye exam can help detect early signs of serious health conditions such as diabetes and hypertension, which makes regular eye exams even more important because what may sometimes seem like a vision-related problem might actually be an indication of a broader health issue. Beginning in 2021, specific VSP providers will offer Ohio State vision plan members an opportunity to use their routine eye exam to detect such medical issues. If, during the exam, a member is identified as being at high risk, the VSP provider will offer educational resources as well as refer members to their primary care physician for further evaluation.

Related Information

Effective Jan. 1 – Dec. 31, 2021

PDF Version

Benefit Basic Plan Coverage1 Premier Plan Coverage4
Description Copay Description Copay
WellVision Exam
  • Focuses on your eyes and overall wellness
  • Every calendar year
$0
  • Focuses on your eyes and overall wellness
  • Every calendar year
$0
Prescription Glasses Prescription Glasses $25 Prescription Glasses $25
Prescription Glasses: Frames
  • $155 allowance for a wide selection of frames
  • $175 allowance for featured frame brands
  • 20% savings on the amount over your allowance
  • Every other calendar year
Included in Prescription Glasses
  • $200 allowance for a wide selection of frames
  • $220 allowance for featured frame brands
  • 20% savings on the amount over your allowance
  • Every calendar year
Included in Prescription Glasses
Prescription Glasses: Lenses
  • Single vision, lined bifocal, and lined trifocal lenses
  • Impact-resistant lenses for dependent children
  • Every calendar year
Included in Prescription Glasses
  • Single vision, lined bifocal, and lined trifocal lenses
  • Impact-resistant lenses for dependent children
  • Every calendar year
Included in Prescription Glasses
Prescription Glasses: Lens Enhancements
  • Standard progressive lenses
  • Premium progressive lenses
  • Custom progressive lenses
  • Average savings of 20-25% on other lens enhancements
  • Every calendar year
$0
$95 – $105
$150 – $175
  • Standard progressive lenses
  • Premium progressive lenses
  • Custom progressive lenses
  • Average savings of 20-25% on other lens enhancements
  • Every calendar year
$0
$95 – $105
$150 – $175
Contacts (instead of lenses)
  • $130 allowance for contacts; copay does not apply
  • Contact lens exam (fitting and evaluation)
  • Every calendar year
Up to $60
  • $150 allowance for contacts; copay does not apply
  • Contact lens exam (fitting and evaluation)
  • Every calendar year
Up to $60
VSP EasyOptions (choose one of these upgrades) Not Applicable
  • An additional $50 frame allowance, or
  • Fully covered premium or custom progressive lenses, or
  • Fully covered light-reactive lenses, or
  • Fully covered anti-glare coating, or
  • An additional $50 contact lens allowance
  • Every calendar year
Included in Prescription Glasses
VSP Diabetic Eyecare Plus ProgramSM
  • Retinal screening for members with diabetes
  • Additional exams and services for members with diabetes, glaucoma, or age-related macular degeneration.Limitations and coordination with your medical coverage may apply. Ask your VSP doctor for details.
  • As needed
$0
$20 per exam
  • Retinal screening for members with diabetes
  • Additional exams and services for members with diabetes, glaucoma, or age-related macular degeneration.Limitations and coordination with your medical coverage may apply. Ask your VSP doctor for details.
  • As needed
$0
$20 per exam
Extra Savings Glasses and Sunglasses

  • Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details
  • 20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within 12 months of your last WellVision Exam

Routine Retinal Screening

  • No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam

Laser Vision Correction

  • Average 15% savings on the regular price or 5% savings on the promotional price; discounts only available from contracted facilities
  • After surgery, use your frame allowance (if eligible) for sunglasses from any VSP doctor
1 with a VSP Provider
*Only available to VSP members with applicable plan benefits. Frame brands and promotions are subject to change. Savings based on doctor’s retail price and vary by plan and purchase selection; average savings determined after benefits are applied. Ask your VSP network doctor for more details.

YOUR COVERAGE WITH OUT-OF-NETWORK PROVIDERS
Get the most out of your benefits and greater savings with a VSP network doctor. Call Member Services for out-of-network plan details.

Coverage with a retail chain may be different or not apply. EasyOptions Plan Benefits are not available at Walmart or Costco. VSP guarantees coverage from VSP providers only. Coverage information is subject to change. In the event of a conflict between this information and your organization’s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location. In the state of Washington, VSP Vision Care, Inc., is the legal name of the corporation through which VSP does business.