Page 14 - Career Group Benefits Guide 2020 OOS

VISION & DENTAL PLANS

Vision Plan Highlights

Anthem Blue Cross | Vision PPO
Anthem Blue Cross provides vision coverage through Blue View Vision. You can see a Blue View Vision in-network pro-
vider 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 Cross
Plan Name PPO
Network Name Blue View Vision Non-Network
Vision Benefits
Copay
- Examination (Every 12 Months) $10 Copay Up to $49 Reimbursement
- Materials $25 Copay N/A
Lenses (Every 12 Months)
- Single Vision No Charge Up to $35 Reimbursement
- Bifocal No Charge Up to $49 Reimbursement
- Trifocal No Charge Up to $74 Reimbursement

Frames (Every 12 Months) $130 Benefit, Up to $50 Reimbursement
then 20% remaining balance

Contact Lenses (Every 12 Months) (in lieu of frames and lenses)
- Cosmetic / Elective $130 Benefit, Up to $92 Reimbursement
then 15% remaining balance
- Medically Necessary No Charge Up to $250 Reimbursement
Laser Vision Correction Discounts Apply Not Covered

Finding a Vision Provider
• Go to www.anthem.com/ca/find-doctor
• Select Search as a Guest by Selecting a Plan Click Continue
• What type of care are you searching for? Select Vision
• Select your state
• Select Blue View Vision

14 Employee Benefits