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Introduction

Your Vision Plan is administered by Anthem Blue View Vision. You can receive care from any licensed eye care professional, but if you see an Anthem in-network provider, you receive a higher level of benefits and there are no claim forms to file. To find a provider, visit www.anthem.com. ID cards are provided for this plan. Vision coverage is included on your Anthem medical ID card, if you are enrolled in the Health Plan as well.

Vision Plan Coverage Chart
Plan Features In-Network Out-of-Network

Frequency of Service

  • Exams
  • Lenses/Contacts
  • Frames

 

  • Once every calendar year
  • Once every calendar year
  • Once every other calendar year

 

  • Once every calendar year
  • Once every calendar year
  • Once every other calendar year

Exams
Frames
Lenses

  • Single Vision
  • Bifocal
  • Trifocal

No copay
No copay (up to $130 retail), then 20% off any remaining balance

  • $10 copay
  • $10 copay
  • $10 copay

Up to a maximum allowance of $35
Up to a maximum allowance of $45

  • Up to a maximum allowance of $25
  • Up to a maximum allowance of $40
  • Up to a maximum allowance of $55

Contacts (in lieu of prescription eyeglass lenses)

Up to a maximum allowance of $130. This benefit applies to one order of contact lenses per calendar year Up to a maximum allowance of $105. This benefit applies to one order of contact lenses per calendar year
Vision Plan Rates for Active Employees
2021 Vision Plan Monthly Employee Contributions (pre-tax payroll deductions)
  Employee Only Employee + Spouse Employee + Children Employee + Family
Vision Plan $7.00 $12.00 $13.00 $20.00
Vision Plan Rates for Pre-65 Retirees

Retirees under age 65 are eligible for the same vision coverage as MPC active employees.

* This Plan is not open to new enrollment. Please check with the Benefits Service center on your eligibility.

Pre-65 Retiree Vision Plan – 2021 Monthly Contributions
  Retiree Only Retiree + Spouse Retiree + Children Retiree + Family
Vision Plan $7.00 $12.00 $13.00 $20.00

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