Page 13 - 2019 Murphy Benefits Enrollment
P. 13
2019
Murphy Company Benefits Enrollment
VISION Contributions
Monthly
We partner with Anthem to offer you and your family members vision Employee $6 .78
insurance. You may choose from many private practice doctors, local Employee and $13 .58
optical stores, and national retail stores including LensCrafters, Target Spouse
Optical, Sears Optical, JCPenney Optical and most Pearle Vision Employee and $13 .72
locations. You may also use your in-network beneits to order eyewear Child(ren)
Employee and Family
online at Glasses.com and ContactsDirect.com. To locate a participating $21 .90
network eye care doctor or location, go to anthem.com and select the
Blue View Vision network. You may also call member services for
assistance at 866.723.0515.
If you choose to, you may instead receive covered beneits outside of
the Blue View Vision network. Just pay in full at the time of service,
obtain an itemized receipt, and ile a claim for reimbursement up to your
maximum out-of-network allowance.
In-Network Out-of-Network
Copay
Exam $10 copay Up to $42
Lenses
Single $25 copay Up to $40
Bifocal $25 copay Up to $60
Trifocal $25 copay Up to $80
Frames
$130 allowance, then Up to $45
20% of
Contacts
Elective Conventional $130 allowance, then Up to $105
15% of
Elective Disposable $130 allowance Up to $105
Medically Necessary Covered in full Up to $210
Frequency
Exam 12 months
Lenses 12 months
Contacts (in lieu of glasses) 12 months
Frames 12 months
This is a high level summary of your beneit coverage. Full coverage details are available in your
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
13
Murphy Company Benefits Enrollment
VISION Contributions
Monthly
We partner with Anthem to offer you and your family members vision Employee $6 .78
insurance. You may choose from many private practice doctors, local Employee and $13 .58
optical stores, and national retail stores including LensCrafters, Target Spouse
Optical, Sears Optical, JCPenney Optical and most Pearle Vision Employee and $13 .72
locations. You may also use your in-network beneits to order eyewear Child(ren)
Employee and Family
online at Glasses.com and ContactsDirect.com. To locate a participating $21 .90
network eye care doctor or location, go to anthem.com and select the
Blue View Vision network. You may also call member services for
assistance at 866.723.0515.
If you choose to, you may instead receive covered beneits outside of
the Blue View Vision network. Just pay in full at the time of service,
obtain an itemized receipt, and ile a claim for reimbursement up to your
maximum out-of-network allowance.
In-Network Out-of-Network
Copay
Exam $10 copay Up to $42
Lenses
Single $25 copay Up to $40
Bifocal $25 copay Up to $60
Trifocal $25 copay Up to $80
Frames
$130 allowance, then Up to $45
20% of
Contacts
Elective Conventional $130 allowance, then Up to $105
15% of
Elective Disposable $130 allowance Up to $105
Medically Necessary Covered in full Up to $210
Frequency
Exam 12 months
Lenses 12 months
Contacts (in lieu of glasses) 12 months
Frames 12 months
This is a high level summary of your beneit coverage. Full coverage details are available in your
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
13
