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Dental Insurance

Give your teeth something to chatter about. With your Anthem PPO dental plan, Dental Complete, go to any dentist you want;
however, it’s less expensive to see an in-network dentist (one that has a contract with Anthem). Non-network dentists can
charge you whatever they want and Anthem will only pay for what’s average for the area—you are responsible for the rest.
You can find dentists on Anthem’s website: www.anthem.com/ca.

ANTHEM

Network Anthem Network Non-Network

YOUR COST PER PAYCHECK
Just You $3
• You + Spouse/Partner $5
• You + Child(ren) $6
• You + Family $9
DENTAL COSTS

Calendar Year Maximum Benefit $2,500 $2,000

Annual Deductible $25 / $50 $50 / $100
• Individual / Family

Preventive Services (Plan Pays) 100% (Deductible Waived) 100% of Area Average Cost
(Deductible Waived)

Basic Services (Plan Pays) 90% 80%

Major Services (Plan Pays) 60% 50%
Cosmetic Bleaching (Plan Pays) 60% 50%

Orthodontia (Adult & Children) 50% with $2,000 Lifetime Maximum

Vision Insurance

Take a real look-see. With your Anthem PPO vision plan, you can see any eye doctor you want; however, it is less expensive to
go to an in-network doctor (one that has a contract with Anthem). You can find in-network doctors on Anthem’s website:
www.anthem.com/ca. For non-network care, you pay the cost upfront, and submit for reimbursement from Anthem.

ANTHEM

Network Anthem Network Non-Network

YOUR COST PER PAYCHECK

Just You $1
• You + Spouse/Partner $2
• You + Child(ren) $2
• You + Family $3

VISION COSTS
Examination (Every 12 Months) $15 Up to $49

Lenses (Every 12 Months)
• Single Vision / Bifocal / Trifocal 100% Up to $35 / $49 / $74

Frames (Every 12 Months) $130 Allowance Up to $50

Elective Contact Lenses In Lieu of Frames & Lenses In Lieu of Frames & Lenses
(Every 12 Months) $130 Allowance Up to $92

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