Page 21 - Realty One Benefits Guide CA

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’s network includes access to more than 44,000 providers and provider locations including independent ophthalmologists and
optometrists, as well as LensCrafters®, Target Optical, Sears Optical, JCPenney Optical and most Pearle Vision retail stores.

Anthem Blue Cross
Plan Features
Blue View Vision Plan
Network Blue View Non-Network
VISION BENEFITS

Copay
• Examination $10 Copay N/A
• Materials $10 Copay N/A
Examination (Every 12 Months) 100% $49 Reimbursement
Lenses (Every 12 Months)
• Single Vision 100% $35 Reimbursement /VISION INSURANCE
• Bifocal 100% $49 Reimbursement
• Trifocal 100% $74 Reimbursement
• Transitions (adults) $75 Copay Not Covered
• Transitions (children under age 19) 100% Not Covered
• Standard Polycarbonate (adults) $40 Copay Not Covered
• Standard Polycarbonate (children under age 19) 100% Not Covered
• Factory Scratch Coating 100% Not Covered
• UV Coating $15 Copay Not Covered
• Tint (Solid and Gradient) $15 Copay Not Covered
• Progressives $65-$110 Copay Not Covered
• Anti-Reflective Coating $45-$68 Copay Not Covered
Frames (Every 24 Months) $130 Allowance $50 Reimbursement
Additional 20% off Balance
Contact Lenses (Every 12 Months) (in lieu of frames and lenses)
• Conventional/Disposable $130 Allowance (Additional 15% off $92 Reimbursement
Balance for Conventional Lenses)
• Medically Necessary $0 Copay $250 Reimbursement

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