Page 10 - Open Sky Brochure - Salaried 2021-2022
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9/1/2021-8/31/2022 Employee Benefits Brochure
Salaried
Vision Plan – Anthem
In- Network Out-of-Network
Exam Copay
(once every 12 months) $10 $42 allowance
Materials Copay
$25 See max reimbursements below
Lenses
(once every 12 months)
Single Covered after $25 copay
Bifocal Covered after $25 copay
$40 - $80 allowances
Trifocal Covered after $25 copay
Lenticular Covered after $25 copay
Frames $150 allowance + 20% off
remaining balance $45 allowance
(once every 24 months)
Contact Lenses
(once every 12 months)
Medically Necessary Covered 100% $210 allowance
Elective $150 allowance $105 allowance
Blue View VisionSM has one of the nation’s largest vision networks. You can access independent
optometrists, ophthalmologists and opticians, Glasses.com, ContactsDirect,1-800 CONTACTS, and convenient
national optical retailer stores including LensCrafters®, Pearle Vision® and Target Optical.® To find an in-
network provider near you, use the Find a Doctor tool on anthem.com/ca
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