Page 16 - Veritone EE Guide 07-19_FINAL.pub
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Veritone 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


                                                  Additional In-Network Savings









                                  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.
                                                       Eyeglass Lens Upgrades  Transition Lenses (Adults): $75 copay  Standard Polycarbonate (Adults): $40 copay  Tint (Solid and Gradient): $15 copay   UV Coating: $15 copay  Progressive Lenses: $65-$110 copay  Anti-Reflective Coating: $45-$68 copay  Other Add-ons: 20% Off Retail Price   Additional Pair of Eyeglasses  Complete Pair: 40% off retail price  Eyeglass materials purchase separately: 20% off retail   Eyewear Accessories  Item













                                                                               price             





                                             Non-Network      N/A   N/A   Up to $49 Reimbursement     Up to $35 Reimbursement  Up to $49 Reimbursement  Up to $74 Reimbursement   Up to $50 Reimbursement   Up to $92 Reimbursement  Up to $250 Reimbursement   Not Covered




                                     Anthem Blue Cross   PPO                        (in lieu of frames and lenses)


                 VISION PLAN




                                             Blue View Vision      $10 Copay   $25 Copay   No Charge      No Charge   No Charge   No Charge   $130 Benefit, then    20% Discount   $130 Benefit   No Charge   Discounts Apply   including independent ophthalmologists and optometrists, as well as LensCrafters®, Target









                        Anthem Blue Cross | Vision Plan

                                                                                                             Anthem’s network includes access to more than 44,000 providers and provider locations
                                                                                                        Go to www.anthem.com/ca. Refer to the Blue View Vision network   Optical, Sears Optical, and JCPenney Optical .










                                        Plan Name   Network Name   Vision Benefits    - Examination    - Materials   Examination (Every 12 Months)   Lenses (Every 12 Months)    - Single Vision    - Bifocal    - Trifocal   Frames (Every 12 Months)   Contact Lenses (Every 12 Months)    - Cosmetic / Elective    - Medically Necessary   Laser Vision Correction   Finding a Vision Provider   EMPLOYEE BENEFITS






                                                    Copay                                                                16
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