Page 13 - PetVet 2022 Master Benefits Guide_FINAL Version

Vision

PetVet offers comprehensive vision coverage through Anthem BlueCross
BlueShield

Anthem BlueCross
BlueShield High Plan Low Plan
Out-of-Network Out-of-Network
In-Network In-Network
Reimbursement Reimbursement
Frequency
Exam Plan Year Plan Year
Lenses / Contacts Plan Year Plan Year
Frames Plan Year Plan Year
Exam
Comprehensive $10 Copay $49 $20 Copay $49

Frames
$180 allowance; $130 allowance;
Eyeglass Frames $50 $50
20% off balance 20% off balance
Lenses (instead of contacts)
Single Vision $10 Copay $35 $20 Copay $35

Bifocal $10 Copay $49 $20 Copay $49

Trifocal $10 Copay $74 $20 Copay $74

Standard Progressive $65 Copay Not Covered $65 Copay Not Covered

Contact Lenses (Instead of eyeglass lenses)
Medically necessary Covered 100% $210 Covered 100% $210

Conventional (non- $180 allowance; $92 $130 allowance; $92
disposable) 15% off balance 15% off balance

Disposable $180 allowance $92 $130 allowance $92

 All benefits information outlined are subject to plan provisions and contract details. The highlighted
benefits are only a brief summary. Please refer to the SPD and/or supporting plan materials posted
in the Company Corner.
 Under both plan options, members can receive an exam, frames and lenses (either hard lenses or
contact lenses) once per plan year (7/1 – 12/31)

Want To Find a Participating Provider?

Visit www.anthem.com then select “Find a Doctor” and choose the Blue View Vision
network. Then narrow your search by name, specialty or geographic area.

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