Page 10 - 2015 Enrollment Guide
P. 10
Beneits Guide
Vision Plan
AAF offers optional vision insurance through Anthem BlueCross
BlueShield utilizing the Select Network. For more information, visit
www.anthem.com.
In-Network Frequency
Eye Exam $0 Copay Once every 12 months
Lenses
Single Vision Covered in full Once every 12 months
Bifocal Covered in full Once every 12 months
Trifocal Covered in full Once every 12 months
Lens Options (Add-Ons) *
Factory Scratch Coating $0 Copay Once every 12 months
Standard Polycarbonate $0 Copay
(Child under 19)
Standard Polycarbonate $40 Copay
(Adults)
Tint (Solid and Gradient) $15 Copay
UV Coating $15 Copay
Standard Progressive $65 Copay
Lenses
Standard Anti-Relective $45 Copay
Coating
Other Add-ons and 20% off retail price
Services
Frames $130 allowance then 20% Once every 24 months
off remaining balance
Contacts Lenses
Elective Conventional $130 allowance, then 15% Once every 12 months
off any remaining balance
Elective Disposable $130 allowance
Medically Necessary Covered in full
* Premium/Enhanced Add-ons may be subject to different copays.
10
Vision Plan
AAF offers optional vision insurance through Anthem BlueCross
BlueShield utilizing the Select Network. For more information, visit
www.anthem.com.
In-Network Frequency
Eye Exam $0 Copay Once every 12 months
Lenses
Single Vision Covered in full Once every 12 months
Bifocal Covered in full Once every 12 months
Trifocal Covered in full Once every 12 months
Lens Options (Add-Ons) *
Factory Scratch Coating $0 Copay Once every 12 months
Standard Polycarbonate $0 Copay
(Child under 19)
Standard Polycarbonate $40 Copay
(Adults)
Tint (Solid and Gradient) $15 Copay
UV Coating $15 Copay
Standard Progressive $65 Copay
Lenses
Standard Anti-Relective $45 Copay
Coating
Other Add-ons and 20% off retail price
Services
Frames $130 allowance then 20% Once every 24 months
off remaining balance
Contacts Lenses
Elective Conventional $130 allowance, then 15% Once every 12 months
off any remaining balance
Elective Disposable $130 allowance
Medically Necessary Covered in full
* Premium/Enhanced Add-ons may be subject to different copays.
10
