Anthem Blue View vision www.anthem.com/ca
| Frequency (exam/frames/lenses) | 12 months / 12 months / 12 months |
| |
In Network |
Out of Network |
| Routine eye exam | $10 copay | $49 allowance |
| Frames | $110 allowance then 20% off balance | $50 allowance |
| Lenses - Standard | | |
º Plastic single vision lenses (1 pair) | $25 copay, then covered in full | $35 allowance |
| º Plastic bifocal lenses (1 pair) | $25 copay, then covered in full | $49 allowance |
| º Plastic trifocal lenses (1 pair) | $25 copay, then covered in full | $74 allowance |
| Lens Upgrades | Member cost for upgrades | |
| º UV Coating | $15 |
Discounts on lens upgrades are not available out-of-network |
| º Tint (Solid and Gradient) | $15 |
| º Standard Polycarbonate | $40 |
º Transitions® lenses | $75 |
| º Other Photochromics | $75 |
| º Progressive lenses
1 | $65 - $103 depending on option |
| º Anti-Reflective Coating
2 | $$45 - $68 depending on option |
| º Other add-ons and Services | 20% off retail price |
| Contact lenses | | |
| º Elective Conventional Lenses | $115 allowance then 15% off balance | $92 allowance |
| º Elective Disposable lenses | $115 allowance (no additional discount) | $92 allowance |
| º Non Elective contact lenses | Covered in full | $250 allowance |
| Contact Lens fitting and follow-up | | |
| º Standard contact fitting
3 | Up to $55 in additional member costs | Discounts not available out of network |
| º Premium contact lens fitting
4 | 10% off retail price |
- Please ask your provider for his/her recommendation as well as the progressive brands by tier.
- Please ask your provider for his/her recommendation as well as the coating brands by tier.
- A standard contact lens fitting includes spherical clear contact lenses for conventional wear and planned replacement. Examples include but are not limited to disposable and frequent replacement.
- A premium contact lens fitting includes all lens designs, materials and specialty fitting other than standard contact lenses. Examples include but are not limited to toric and multifocal.
Anthem contracts with approximately 4,600 independent optometrists and ophthalmologists as well as retail locations such as LensCrafters, Target Optical, Sears Optical & most Pearle vision locations. Log onto Anthem's web site @
www.anthem.com/ca to search for additional providers
15 16
