DeltaVision Summary of Vision Plan Benefits for Elkhart Community Schools
This document outlines the vision care benefits and conditions provided by Delta Dental for Elkhart Community Schools, detailing coverage for services like eye exams and retinal screenings.
DeltaVision Summary of Vision Plan Benefits For Group# V1300-0001, 0002, 0099 Elkhart Community Schools This Summary of Vision Plan Benefits should be read along with your Certificate. Your Certificate provides additional information about your DeltaVision plan. If a statement in this Summary conflicts with a statement in the Certificate, the statement in this Summary applies to you and you should ignore the conflicting statement in the Certificate. The percentages below are applied to Delta Dental's allowance for each service and it may vary due to the Provider’s network participation.* Control Plan – Delta Dental of Indiana Benefit Year – January 1 through December 31 Delta Dental will provide vision care Benefits according to the Schedule listed below. This Schedule lists the vision care Benefits to which Members are entitled, subject to any applicable Copayments and other conditions, limitations and/or exclusions stated herein. Administrative Services for the adjudication of claims and the payment of Benefits under this Policy will be provided by Vision Service Plan Insurance Company (
DeltaVision Summary of Vision Plan Benefits for Elkhart Community Schools Page 2