Page 11 - Aspiration Partners Employee Benefits Guide – National

Anthem Blue View | Vision Plan
Aspiration provides vision coverage through Anthem Blue View. You can see an Anthem Blue View 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 View
Plan Name PPO
Network Name Blue View Vision Non-Network

Vision Benefits
Copay
- Examination $10 Copay
- Materials $25 Copay
Examination (Every 12 Months) $10 Copay Up to $42 Reimbursement
Lenses (Every 12 Months)
- Single Vision $25 Copay Up to $40 Reimbursement
- Bifocal $25 Copay Up to $60 Reimbursement
- Trifocal $25 Copay Up to $80 Reimbursement
Frames (Every 12 Months) $150 Benefit Up to $45 Reimbursement
Contact Lenses (Every 12 Months) (in lieu of frames and lenses)
- Cosmetic / Elective $150 Benefit Up to $105 Reimbursement
- Medically Necessary No Charge Up to $210 Reimbursement
Laser Vision Correction Discounts Apply Not Covered

Finding a Vision Provider
Go to www.anthem.com/ca. Refer to the Blue View Vision network

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, and most Pearle Vision
retail stores.

Additional Discounts Available
• Eyeglass Lens Upgrades: When obtaining eyewear from a network provider, you may choose to upgrade
your new eyeglass lenses at a discounted cost. Eyeglass lens copays will vary based on the upgrade selected.
• Additional Pairs of Eyeglasses: Receive a 40% discount for a complete pair or a 20% discount for eyeglass
materials (purchased separately) from a network provider.
• Contact Lens Fit and Follow-up: A contact lens fitting and up to two follow-up visits are available to you
once you complete a comprehensive eye exam. A standard contact lens fitting is available at a $55 copay. A
premium contact lens fitting is available for a 10% discount to the retail price.