Page 10 - TCR Benefit Guide 2017 - Non-CA - sent 9.12.17

Benefits

Vision Insurance

Anthem Blue Cross | PPO Vision Plan
The Anthem Blue Cross 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 Blue
Cross.

Anthem Blue Cross Note
Plan Name Blue View Vision Plan Anthem’s vision

Network Name Network Non-Network network includes
access to more than
Vision Benefits 44,000 providers
Copay and provider
- Examination $25 Copay N/A locations including
- Materials $25 Copay N/A independent
ophthalmologists
Examination (Every 12Months) 100% $49 Benefit and optometrists, as
Lenses (Every 24 Months) well as
- Single Vision 100% $35 Benefit LensCrafters®,
- Bifocal 100% $49 Benefit Target Optical, Sears
- Trifocal 100% $74 Benefit Optical, JCPenney
Optical and most
Lens Upgrade Options Pearle Vision retail
- UV Coating $15 stores.
- Tint (Solid and Gradient) $15
- Standard Polycarbonate $40
- Transitions lenses $75 Discounts on lens
- Progressive Lenses $65 - $103 upgrades are
- Standard Anti-Reflective Coating $45 not available
- Premium Tier 1 Anti-Reflective $57 out-of-network
Coating
- Premium Tier 2 Anti-Reflective $68
Coating
- Other Add-ons and Services 20% off retail price
Frames (Every 24 Months) $130 Benefit $50 Benefit
Contact Lenses (Every 24 Months) In Lieu of Frames and Lenses
- Cosmetic / Elective $130 Benefit $92 Benefit

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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