Page 7 - Westmark Benefit Guide 2019-2020

Vision

Anthem | PPO Vision Plan
The Anthem 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.

Plan Features Anthem Blue Cross
PPO Plan
Network Non-Network

Copays - Examination $15 Up to $49
- Materials $15 n/a
Examination 100% up to $49 benefit

Lenses - Single Vision 100% up to $35 benefit
- Lined Bifocal 100% up to $49 benefit
- Trifocal 100% up to $74 benefit
- Progressive $65-$110 copay none
- Lenticular 20% not covered
- Frequency 12 months from date of last service
Frames - Allowance up to $130, then 20% off up to $50 benefit

- Frequency 12 months from date of last service
Contact Lenses (in lieu of frames & lenses)
- Cosmetic / Elective up to $130, then 15% off up to $92 benefit
- Visually Necessary 100% up to $250 benefit
- Frequency 12 months from date of last service

Finding In-Network Vision Providers
Go to www.anthem.com/ca or call (866) 723-0515.

Tips for Using Your Vision Benefits
Anthem’s network includes access to more than 44,000 providers and provider locations including independent ophthalmologists
and optometrists, as well as LensCrafters®, Target Optical, Sears Optical, JCPenney Optical and most Pearle Vision retail stores.

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