2023 Benefits Guide Vision Routine eye exams are important for maintaining good vision and can also provide early warning of other health conditions. The Anthem Blue View Vision plan provides coverage for exams, glasses and contact lenses, as shown below. In-network coverage is provided when you use Anthem Blue View Vision providers. To locate a participating network eye care doctor or location, log in at www.anthem.com, or from the home page menu under Care, select Find a Doctor.If you choose to, you may instead receive covered benefits outside of the BlueView Vision network. Just pay in full at the time of service, obtain an itemized receipt, and file a claim for reimbursement up to your maximum out-of-network allowance. You can email claim forms to: [email protected] mail to: Blue View Vision, OON Claims, P.O. Box 8504, Mason, OH 45040-7111. You may choose from many private practice doctors, local optical stores, and national retail stores including LensCrafters®, Target Optical®, and most Pearle Vision® locations. You may also use your in-network benefits to order eyewear online at Glasses.com and ContactsDirect.com. No ID card will be provided; give the group number and your SSN to your provider when obtaining services. Call 866-723-0515 for card requests Anthem Blue View Vision Frequency In-Network Out-of-Network You Pay Plan Allowance / Reimbursement Eye Exam Once every $10 copay Up to $42 calendar year Eyeglass Frames (1 pair) Once every $180 allowance, then 20% of Up to $45 calendar year remaining balance Lenses-instead of contacts Once every $10 copay Up to $40/$60/$80 (Singlevision/lined bifocal/lined trifocal) calendar year ProgressiveLenses(Standard) Once every $55 copay, in addition to other N/A calendar year applicable charges Contacts—insteadofglasses (Elective Once every $180 allowance + 15%/180 Up to $105/$105/$210 conventional/elective disposable/non-elective) calendar year allowance/covered in full Savings on items like additional eyewear after your benefits have been used, non-prescription sunglasses, hearing aids and even LASIK laser vision correction surgery are available through a variety of vendors. Just log in at anthem.com. For list of exclusions and limitations, please refer to the certificate of coverage for this plan. 21 WestCare