Page 15 - Paragon Services Engineering 2019 Employee Benefits

Anthem Blue Cross | PPO Vision Plan
The Anthem Blue Cross vision plan provides professional vision care and high quality lenses and frames through a
broad network of optical specialists. You will receive richer benefits if you utilize a network provider. If you utilize a
non-network provider, you will be responsible to pay all charges at the time of your appointment and will be
required to file an itemized claim with Anthem Blue Cross.

Anthem Blue Cross
Plan Name PPO
Network Name Blue View Vision Non-Network

Vision Benefits
Copay
- Examination $25 Copay N/A
- Materials No Charge N/A

Examination (Every 12 Months) $25 Copay $49 Reimbursement

Lenses (Every 12 Months)
- Single Vision No Charge $35 Reimbursement
- Bifocal No Charge $49 Reimbursement
- Trifocal No Charge $74 Reimbursement
Frames (Every 12 Months) $130 Allowance,
20% off remaining balance $50 Reimbursement
Contact Lenses (Every 12 Months) In Lieu of Frames and Lenses

- Cosmetic / Elective $130 Allowance $92 Reimbursement
- Medically Necessary No Charge $250 Reimbursement

Laser Vision Correction Discounts Apply Not Covered

Finding a Vision Provider
Go to www.anthem.com/ca or call (866) 723-0515. Refer to the Blue View
Vision” network.