Page 7 - Kagan Benefit Guide CA.pub

Principal
Plan Features EPO Plan
Network Name EPO
Calendar Year Maximum $2,000
Deduc ble (Annual) $0
‐ Individual/ Family
Preven ve (Plan Pays) 100% for Most Services
Note Exams, X‐Rays, Cleanings
Kagan provides you with a selec on of Basic Services (Plan Pays) 100%
benefit op ons so you may choose the Fillings, Oral Surgery
coverage that is best for you and your family.
Major Services (Plan Pays) 100%
Crowns, Prosthe cs
Orthodon a
Finding a Dental Provider Children & Adults
Go to www.principal.com or call (800) ‐ Coinsurance 50%
986‐3343. POS par cipants should refer
to the POS network and EPO par cipants ‐ Life me Benefit Maximum $1,500
should refer to the EPO network when
prompted. Rollover Feature 50% up to $1,000

Benefits

Anthem Blue Cross
Blue View Vision Vision
Network Name In‐Network Non‐Network Insurance
Vision Benefits

Copay The Anthem Blue Cross vision
plan provides professional
‐ Examina on $10 Copay $49 allowance vision care and high quality
‐ Materials $20 Copay allowance varies
lenses and frames through a
broad network of op cal
Lenses
specialists. You will receive
‐ Single Vision No charge $35 allowance richer benefits if you u lize a
‐ Bifocal No charge $49 allowance network provider. If you u lize
‐ Trifocal No charge $74 allowance a non‐network provider, you
will be responsible to pay all
Frames $130 allowance, then 20% off $50 allowance
charges at the me of your
any remaining balance appointment and will be
required to file an itemized
Contact Lenses In Lieu of Frames and Lenses
claim with Anthem.
‐ Cosme c / Elec ve $130 allowance $92 allowance
‐ Medically Necessary Covered in full $250 allowance

Laser Vision Correc on Discounts Apply Not Covered
Frequency
‐ Examina on 12 Months
‐ Lenses 12 Months
‐ Frames 12 Months
‐ Contact Lenses 12 Months

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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