Page 16 - HM Benefits Guide 2019 CA

Vision Plan

Anthem Blue Cross | PPO Vision Plan
You will be auto-enrolled in this plan at NO COST to you*
Our vision plan allows you to see any eye doctor you’d like; however, it’s less expensive to go to an in-
network doctor (one that has a contract with Anthem). For non-network care, you’ll pay the cost upfront
and submit a claim for reimbursement to Anthem Blue Cross.

Anthem Blue Cross
PPO

Network Name PPO Network Non-Network
Vision Benefits

Copay
• Examination $10 Copay N/A
• Materials $25 Copay N/A
Examination (Every 12 Months) No Charge Up to $49 Reimbursement
Lenses (Every 12 Months)
• Single Vision No Charge Up to $35 Reimbursement
• Bifocal No Charge Up to $49 Reimbursement
• Trifocal No Charge Up to $74 Reimbursement
Frames (Every 12 Months) $130 Allowance, then 20% Up to $50 Reimbursement
Discount
Contact Lenses (Every 12 (in lieu of frames and lenses)
Months)
• Cosmetic / Elective $130 Allowance, Up to $92 Reimbursement
then 15% Discount
• Medically Necessary No Charge Up to $250 Reimbursement

*You must actively opt-out in PlanSource if you wish to decline vision benefits.

Anthem’s network includes access to more than 44,000 providers and provider
locations including independent ophthalmologists and optometrists, as well as
LensCrafters, Target Optical, JCPenney Optical, Glasses.com, ContactsDirect,
and most Pearle Vision retail stores.
Finding a Provider
Go to www.anthem.com/ca. Refer to the “Blue View Vision” network when
prompted.

Tip: Anthem offers savings on items like additional eyewear after your benefits have been
used, non-prescription sunglasses, eyeglass lens upgrades, hearing aids, and LASIK laser
vision correction. Just log in to www.anthem.com/ca, select discounts, then Vision, Hearing &
Dental.

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