Page 10 - Electric Ben Guide 08-18
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VISION
With the Anthem Blue Cross Vision plan, 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
PLAN FEATURES VISION PLAN H
Network Network Non-Network
Deductible $10 Exam / $25 Materials
Examination (Every Calendar Year) 100% $42 Benefit FINDING
Lenses (Every Calendar Year)
Single Vision / Bifocal / Trifocal 100% $40 / $60 / $80 A VISION
Benefit
Frames (Every Two Calendar Years) $130 Benefit $45 Benefit PROVIDER:
Contact Lenses (Every Calendar Year) Go to www.anthem.com/
(in lieu of frames and lenses) ca/findadoctor. Refer to
Cosmetic / Elective $130 Benefit $60 Benefit the “Blue View Vision”
Visually Necessary 100% $210 Benefit network.
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