Page 10 - Benefits Guide TeleSign 2020

Vision Insurance

Anthem Blue Cross | PPO
TeleSign provides vision coverage through Anthem Blue Cross. You can see an Anthem Blue Cross in-network provider or an out-of-
network provider; however, your costs will be lower if you visit an in-network provider. If you visit an in-network provider you will
be responsible for a copayment at the time of your service. If you receive services from an out-of-network doctor, you will pay all
costs at the time of service and submit a claim for reimbursement.

Anthem Blue Cross Note
Plan Name Vision Anthem’s Network
includes access to
Network Name Choice Non-Network
more than 44,000
Vision Benefits providers, including:
independent
Examination (Every 12 Months) $10 Copay Up to $49 Reimbursement
ophthalmologists
and optometrists, as
Frames (Every 12 Months) $130 Benefit, 20% Discount Up to $50 Reimbursement
well as
LensCrafters®,
Lenses (Every 12 Months)
Target Optical, Sears
One pair of standard plastic lenses: Optical, JCPenney
- Single Vision $10 Copay Up to $35 Reimbursement Optical and most
- Bifocal $10 Copay Up to $49 Reimbursement Pearle Vision retail
- Trifocal $10 Copay Up to $75 Reimbursement stores.
Contact Lenses (Every 12 Months) In Lieu of Frames and Lenses
- Cosmetic / Elective $130 Benefit, 15% Discount Up to $92 Reimbursement
- Disposable $130 Benefit Up to $92 Reimbursement
- Medically Necessary No Charge Up to $250 Reimbursement

Finding a Vision Provider
• Go to www.anthem.com/ca
• Select “Find a Doctor”
• Search as a guest and answer the questions.
• Refer to the “Blue View Vision” network.

Additional Discounts Available
• Children under age 19 are eligible to receive transitions and standard polycarbonate lens enhancements for no charge.
• Factory scratch coating lens enhancement is available at no charge.
• Additional Eyeglass Lens Upgrades are also available at a discounted cost when obtaining eyewear from a Blue View Vision
providers.
• Additional Pairs of Eyeglasses: You may receive additional pairs of eyeglasses anytime from any Blue View Vision provider. 40%
off a complete pair or 20% off eyeglass materials purchased separately.
• Eyewear Accessories: Items such as non-prescription sunglasses, lens cleaning supplies, contact lens solutions, eyeglass cases,
and more are available at a 20% discount.
• Contact Lens Fit and Follow-Up: A contact lens fitting and up to two follow-up visits are available to you at a $55 copay once a
comprehensive eye exam has been completed. You may upgrade to a premium contact lens fitting with a 10% discount off the
difference.

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