Overview

Vision insurance is offered through DeltaVision (in partnership with EyeMed). This insurance provides benefits for eye exams and materials (contacts and/or glasses). For plan details, see the Vision Summary and/or Vision Brochure in the Forms & Resources section below.

Eligibility

You must meet the following requirements to be eligible for vision insurance:

  • Eligible for State Group Health Insurance; and
  • Are not receiving a Wisconsin Retirement System (WRS) annuity.

For information on who you can cover on this plan, see the Dependent Eligibility Chart (UWS 25) pdf .

Coverage

Schedule of Benefits In-Network Out-of-Network
Annual Routine Exam Copay $15 per person Up to $45 per person
Eyeglasses Exam Copay $15 per person Up to $45 per person
Contact Lens Exam Copay $40 per person Up to $45 per person
Retinal Imaging Copay Up to $39 per person No coverage
Frames $150 allowance per person Up to $70 per person
Benefit Frequency

Lenses

Frames

 

12 months

24 months adults, 12 months children

 

12 months

24 months

Eyeglasses Copay

Single vision

Bifocal vision

 

$25 per person

$25 per person

 

Up to $30 per person

Up to $50 per person

Progressive Lenses Standard: Covered in full

Premium: $95 – $105

Custom: $150 – $175

Up to $50 per person
Conventional and Disposable Contacts $150 allowance per person Up to $105 per person
Contact Lens Fitting / Follow-up Visit Standard: Up to $40 per person

Premium: 10% off retail price

No coverage

Provider Network

For lower out-of-pocket costs, see an in-network vision provider. In-network vision providers will submit claims to the appropriate vision insurance administrator on your behalf.

There are out-of-network benefits for the vision insurance; however, your out-of-pocket cost will likely be higher. In addition, you will need to submit your claims to the vision insurance administrator. Out-of-network providers typically will not submit claims on your behalf.

Not sure if your vision provider is in-network? To find out, in the Forms and Resources section below, click the “Find a Provider” link or contact DeltaVision/EyeMed at their tollfree number.

Enrollment

You have 30 days from your date of employment or newly benefits-eligible position to enroll in vision insurance. Coverage will begin on the first of the month on or following your eligibility date. If you do not enroll during the initial 30-day enrollment period, your next opportunity to do so will be during the Annual Benefits Enrollment period (which occurs each fall) or if you have a qualifying life event. See Life Events for more information.

Note: Once you are enrolled in vision insurance, you must remain enrolled for the entire calendar year.

ID Cards

ID cards are issued by DeltaVision/EyeMed. If enrolled, bring your ID card with you to your appointment. Below are a few notes about your DeltaVision/EyeMed vision insurance ID cards:

  • The member ID on your ID card is a random number assigned by DeltaVision/EyeMed (it is not your Employee ID or SSN)
  • ID cards only list your name (your covered spouse/dependent(s) are not listed)
  • ID cards do not specify the level of coverage (such as single or family)

To verify coverage for your covered spouse and dependents, contact DeltaVision/EyeMed at the tollfree number provided in the Forms and Resources section below. Or register online. If you register online, only your dependents under the age of 18 will appear. Your spouse and dependents over the age of 18 may verify their coverage by registering with the Member ID on your ID card, their first and last name, and their date of birth.

Reminder: ID cards are not necessary to use your vision insurance benefits.

Benefit Premiums

For Vision Insurance premiums review the Benefit Premiums web page.

Forms & Resources


Every effort has been made to ensure this information is current and correct. Information on this page does not guarantee enrollment, benefits and/or the ability to make changes to your benefits.

Updated: 12/16/2021