Dental Insurance
Dental coverage is provided through Delta Dental of Virginia. The LCPS plan is a PPO and is part of the Premier and Preferred networks. Coverage is provided for both in-network and out-of-network services and are based on a Plan Year of January through December.
In-Network
Preventative Services: Covered 100% (2 visits per year)
Basic Services: Covered at 80% after a $50.00 deductible ($150.00 family)
Major Services: Covered at 80% after a $50.00 deductible ($150.00 family)
Out-of-Network
Preventitive Services: Covered 80% of Usual and Customary Rates (UCR) (2 visits per year)
Basic Services: Covered at 60% of UCR after a $50.00 deductible ($150.00 family)
Major Services: Covered at 50% of UCR after a $50.00 deductible ($150.00 family)
Benefit Maximums
The annual benefit maximum for Basic and Major services is $1,250.00 per enrollee per contract year. The benefit maximum is cumulative between in and out-of-network benefits.
Orthodontics are covered at 50% of UCR up to a lifetime maximum of $1000 per person for both in-network and out-of network.
Healthy Smile, Healthy You Program
If you are pregnant, have diabetes, have certain high-risk cardiac conditions or are receiving chemo or radiation for cancer, you are eligible for an extra cleaning and exam beyond our plan's normal annual limit. Find more information on the Healthy Smile, Healthy You program and the Healthy Smile, Healthy You enrollment form under Information, Forms and Resources on the right side of this page.
Vision Insurance
Vision coverage is provided through Davis Vision for routine eye exams, glasses or contact lenses.
In-Network
Eye Exam: $15 co-pay
Lenses: $15 co-pay (Additional fees will apply for extra coatings and specialty lenses)
Frames: A credit of $110 is provided towards the purchase of frames ($160 credit at Visionworks)
Contact Lenses: $100 allowance towards a year supply of contact lenses in lieu of eye glass lenses
Out-of-Network
Eye Exam: Reimbursed up to $35
Lenses: Reimbursed $25 and up for lenses based on type of lens purchased
Frames: Reimbursed up to $35
Contact Lenses: Reimbursed up to $95
Health Insurance Enrollment, Changes and Termination
Visit the Benefits Basics page to find information on:
Eligibility for Benefits
Enrollments and Changes
Making Benefit Elections/Changes
Coverage for Dependents
Qualifying Events/Mid-Year Changes
Termination of Coverage
COBRA Coverage
Information, Forms and Resources
Delta Dental Contact Information
Member Services
1-800-237-6060
Claims Address:
Delta Dental of Virginia
4818 Starkey Rd.
Roanoke, VA 24014
Prevention First
The costs for preventive care are excluded from your annual benefits maximum. Learn more about the Prevention First benefit.
Healthy Smile, Healthy You Program - Extra Cleanings
Members with certain medical conditions (diabetes, undergoing cancer treatments, pregnancy or certain high-risk cardiac conditions) are eligible for extra cleanings through the Healthy Smile, Healthy You Program. To apply, complete Healthy Smile, Healthy You form.
Davis Vision Contact Information
Member Services:
1-888-235-3130
Website:
Client Control Code: 7025
Claims Address:
Vision Care Processing Unit
P.O. Box 1525
Latham, NY 12110