DENTAL & VISION

DENTAL

Weaber offers two Dental Plans with Delta Dental to select. The Delta Base Plan and Delta Buy Up Plan.

Services	Base Plan - In Network	Base Plan - Out of Network	Buy Up Plan - In Network	Buy Up Plan - Out of Network
Annual Deductible (Individual/Family)	None / None	None / None	$50 / $150	$50 / $150
Annual Maximum	$1,000 per person	$1,000 per person	$2,000 per person	$2,000 per person
Preventive & Diagnostic	100%	100%	100%	100%
Basic Restorative Care	80%	80%	80%	80%
Major Restorative Care	0%	0%	50%	50%
Orthodontia	Not Covered	Not Covered	Not Covered	Not Covered

VISION

The Capital Blue Cross 12/0 Optimal Vision Plan provides coverage for eye exams, glasses, or contacts.

Services & Frequency	In-Network Coverage	Out-of-Network Reimbursement
Exam Frequency	Once every 12 months	Once every 12 months
Lenses or Contact Lenses Frequency	Once every 12 months	Once every 12 months
Frames Frequency	Once every 12 months	Once every 12 months
Eye Exam	$0 copay	Allowance Up to $32
Frames	Allowance up to $200, plus 30% off retail balance	Allowance Up to $60
Single Vision Lenses	Covered 100%	Allowance Up to $25
Bifocal Lenses	Covered 100%	Allowance Up to $36
Trifocal Lenses	Covered 100%	Allowance Up to $46
Lenticular Lenses	Covered 100%	Allowance Up to $72
Contact Lenses (Instead of Glasses)	Allowance up to $115, plus 25% off retail balance	Allowance Up to $75

Vision Plan Summary

Find a Vision Provider

Life & Disability