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Benefits

Vision Insurance

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 Note
Plan Name PPO Anthem’s network
includes access to
Network Name Blue View Vision Non-Network
more than 44,000
Vision Benefits providers and
provider locations
Copay including
- Examination $10 Copay N/A independent
- Materials $25 Copay N/A
ophthalmologists
Examination (Every 12 Months) 100% $49 Reimbursement and optometrists, as
well as LensCrafters,
Lenses (Every 12 Months) Target Optical, Sears
- Single Vision 100% $35 Reimbursement Optical, and
- Bifocal 100% $49 Reimbursement JCPenney Optical
- Trifocal 100% $74 Reimbursement retail stores.

Lens Enhancements
- Ultraviolet Coating $15 Copay Applied to Allowance
- Progressive (Standard) $65 Copay Applied to Allowance
- Progressive (Standard) $65 Copay Applied to Allowance
- Progressive (Premium) $85-$110 Copay Applied to Allowance
- Polycarbonate (Adult) $40 Copay Applied to Allowance
- Scratch-resistant Coating* $0 Copay Applied to Allowance
- Tints (Solid and Gradient) Up to $15 Copay Applied to Allowance
- Anti-reflective Coating* Up to $45-$68 Copay Applied to Allowance
Frames (Every 24 Months) $130 Allowance, $50 Reimbursement
then 20% Discount

Contact Lenses (Every 12 Months) In Lieu of Frames and Lenses
- Cosmetic / Elective $130 Allowance $92 Reimbursement
- Medically Necessary 100% $250 Reimbursement
Laser Vision Correction Discounts available Not Covered

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

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