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

2018 Open Enrollment

November 1-14, 2017

Dental and Vision Plans

There are no changes to the Faculty and Staff Dental Plan or the Faculty and Staff Vision Plan designs for 2018.

Dental Plan

The 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.

Effective Jan. 1 – Dec. 31, 2018

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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 and 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 2018 Dental Plan Specific Plan Details (SPD).

NOTE: This Dental Plan Summary Chart should be used as a general guide only. Refer to the 2018 Dental Plan Specific Plan Details (SPD) for further information. If the information in the summary chart differs from the Specific Plan Details Document, the Specific Plan Details Document will govern.

Vision Plan

The 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 benefits.

Effective Jan. 1 – Dec. 31, 2018

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Covered Services Basic Premier Out-of-Network
In-Network Providers Choice Network
Annual Deductible $25 per person, applies to materials only (lenses and frames)
Vision Exam 100% paid; no deductible 100% paid; no deductible Maximum of $45 paid; no deductible
Vision Exam Frequency Every calendar year Every calendar year Every calendar year
Frames Maximum of $155 paid, after annual deductible; 20% discount off any amount over $155

Maximum of $175 paid on featured frame brands1, after annual deductible; 20% discount off any amount over $175

Maximum of $200 paid, after annual deductible; 20% discount off any amount over $200
Maximum of $220 paid on featured frame brands1, after annual deductible; 20% discount off any amount over $220
Maximum of $70 paid, after annual deductible
Frames Frequency Every other calendar year Every calendar year Basic: Every other calendar year
Premier: Every calendar year
Lenses 100% paid, after annual deductible, for:

  • Single Vision Lenses
  • Lined Bifocal Lenses2
  • Lined Trifocal Lenses2
  • Lenticular Lenses2
  • Polycarbonate Lenses for Children
100% paid, after annual deductible, for:

  • Single Vision Lenses
  • Lined Bifocal Lenses2
  • Lined Trifocal Lenses2
  • Lenticular Lenses2
  • Polycarbonate Lenses for Children
Maximum paid as indicated, after annual deductible, for:

  • Single Vision Lenses: $30
  • Any Bifocal Lenses: $50
  • Any Trifocal Lenses: $65
  • Lenticular Lenses: $100
Lenses Frequency Every calendar year Every calendar year Every calendar year
Or Contact Lenses3, 4
(includes disposables)
Up to $60 copay for your contact lens exam (fitting and evaluation)

Maximum of $130 allowance paid toward contact lenses; no deductible

Up to $60 copay for your contact lens exam (fitting and evaluation)

Maximum of $150 allowance paid toward contact lenses; no deductible

Maximum of $105 paid; no deductible
Contact Lenses Frequency Every calendar year Every calendar year Every calendar year
Easy Options Enhancements You and each member on your plan may choose one of these enhanced eyewear options in lieu of one base option above:

  • $250 frame allowance or
  • $200 contact lens allowance or
  • Fully covered progressive lenses or
  • Fully covered photochromic lenses or
  • Fully covered anti-reflective coating

1 Visit vsp.com for more information on VSP’s featured frame brands, as the brands may change.
2 Blended (seamless) lenses are available at Vision Service Plan’s (VSP) preferred member pricing; however, the plan does not pay for any additional charges above the cost of lined lenses.
3 Contact lenses are in lieu of lenses only. Member can receive frame and contact lenses per eligible frequency.
4 Medically Necessary Contact Lenses are a Plan benefit when specific benefit criteria are satisfied and when prescribed by in-network or out-of-network provider. Prior review and approval by VSP are not required for a covered person to be eligible for Medically Necessary Contact Lenses.