Page 11 - 2020 McLennan County Benefits Enrollment Guide

Vision Benefit

McLennan County offers you vision coverage through
NVA (National Vision Administrators, LLC.). NVA offers
a comprehensive vision care plan to you and your eligible family members. NVA only offers In-Network provider
benefits; be sure your care provider is within the network. Contact Information: 800-672-7723 or www.e-nva.com

Summary of Vision Plan Participating Non-Participating Eye Essential Plan:
Options Provider Amounts Provider Participating Provider
Coverage Amounts (2
nd
Pair of Glasses)
Examination (Once Every Plan Covered 100% Reimbursed amount Retail less $10.00
Year) After $10.00 Copay up to $30.00
Contact Lens Evaluation/Fitting Retail less 10%
Lenses: (Once Every Plan Year) Standard Glass or Plastic Up to $25.00 Glass or Plastic
Single Vision Covered 100% Up to $35.00 $35.00
Bifocal After $25.00 Copay Up to $45.00 $55.00
Trifocal Up to $80.00 $70.00
Lenticular $70.00
Frame (Once Every Two Plan Retail Allowance Up to $70.00 Retail less 35%
Years) Up to $120.00
(20% discount off
balance)*
Contact Lenses (Once Every Plan Up to $105.00 Up to $80.00 Retail less 15%
Year; Elective Contact Lenses, (15% discount Retail less 10%
but this is in lieu of lenses & (Conventional) or 10% Medically Necessary
frames) discount (Disposable) off - Up to $210.00
balance)**
Medically Necessary -
Covered 100%
*Does not apply to Wal-Mart / Sam’s Club locations or for certain proprietary brands. **Does not apply to Wal-Mart/Sam’s Club, Contact Fill
(NVA Mail Order) or the following locations: Target, Sears, JC Penney, Boscov’s, Pearle, K-Mart, & Macys (prohibited by some manufacturers).

Lens options purchased from a participating NVA provider will be provided to the member at the amounts listed in
the fixed option pricing list below:
$35.00 Polycarbonate (Single Vision) $12.00 Ultraviolet Coating
$35.00 Polycarbonate (Multi-focal) $12.00 Solid/Gradient Tint
$40.00 Standard Anti-Reflective $10.00 Scratch-Resistant Coating
$65.00 Transitions Single Vision Standard $50.00 Progressive Lenses Standard
$70.00 Transitions Multi-focal Standard $100.00 Premium Progressive Lenses
$75.00 Polarized
Note: Members are entitled to significant discounts and free initial consultations with all in-network providers regarding LASIK procedures.

Dental Benefits

Delta Dental PPO Benefit Highlights
Delta Dental is a Dental Provider Organization plan, which covers expenses that are indicated below:
• Preventive and diagnostic services like routine exams and cleanings, fluoride treatments, topical sealants,
space maintainers and X-rays
• Basic services such as amalgam fillings, root canals, oral surgery (extractions) and periodontics
• Major services such as acrylic/fold/porcelain crowns, bridgework/dentures and composite resin fillings

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