Page 13 - KNCH Benefits Guide 2019 v3

VISION INSURANCE

ANTHEM | PPO VISION PLAN
Available in all states
The Anthem 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.
Anthem utilizes independent ophthalmologists and optometrists as well as a partnership with Lenscrafters, Pearle Vision, Target
Optical, Sears Optical and JC Penny Optical.

Anthem
Plan Features PPO
Network Network Non-Network*
VISION BENEFITS Blue View

Examination (Every 12 Months) 100% $49 Reimbursement
Lenses (Every 12 Months)
Single Vision 100% $35 Reimbursement
Bifocal 100% $49 Reimbursement
Trifocal 100% $74 Reimbursement
Standard Progressive Up to $65 Copay
Premium Progressive (subject to review) Up to $85-$110 Copay

UV Treatment Up to $15 Copay
Tint (Solid and Gradient) Up to $15 Copay
Standard Plastic Scratch Coating 100%
Standard Polycarbonate (Adult) Up to $40 Copay
Standard Anti-Reflective Coating Up to $45 -$68

Frames (Every 12 Months) $130 Allowance, then $50 Reimbursement
20% Discount Off Balance

Contact Lenses (Every 12 Months) In Lieu of Frames and Lenses
Elective Contact Lenses $130 Allowance $92 Reimbursement
Medically Necessary 100% $250 Reimbursement
Standard Contact Fitting & Evaluation Up to $55 Copay

DISCOUNTS
A 20%-40% discount is available for additional pairs of prescription glasses or non-prescription sunglasses and applies to
purchases made after your plan allowances has been exhausted. Additional savings on items like additional hearing aids and even
LASIK laser vision correction surgery are available through a variety of vendors. Just log in at anthem.com/ca, select discounts,
then Vision, Hearing & Dental.

FINDING A VISION PROVIDER:
The Anthem network includes access to independent ophthalmologists and optometrists to include a
partnership with Lenscrafters, Pearle Vision, Target Optical, Sears Optical and JC Penny Optical. Go to
www.anthem.com. Select “Blue View Vision” or call 866.723.0515

13