Vision
Healthy eyes and clear vision are an important part of your overall health and quality of life. You may enroll yourself and your eligible dependents or you may waive vision coverage. You do not have to be enrolled in medical coverage to elect vision coverage or cover the same dependents under medical and vision.
Although vision care services and supplies are covered in-network and out-of-network, your benefits are generally greater when you use in-network providers. Your costs are based on the family members you choose to cover.
Blue Shield Vision (California & Non-California)
Plan Information
Plan Name: Custom Vision Plus with Contacts 0/0/200/200
Policy Number: 32538
Effective Date: 01/01/2025
Network: Blue Shield of California
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Exams
$0
Single Vision Lenses
$0
Bifocal Lenses
$0
Trifocal Lenses
$0
Frames
Up to $200 allowance
Contacts (in lieu of glasses)
Up to $200 allowance
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months
Out-of-Network Reimbursement
Exams
Up to $50 reimbursement
Single Vision Lenses
Up to $43 reimbursement
Bifocal Lenses
Up to $60 reimbursement
Trifocal Lenses
Up to $75 reimbursement
Frames
Up to $40 reimbursement
Contacts (in lieu of glasses)
Up to $200 reimbursement
Frequency
Exams
Once every 12 months
Lenses
Once every 12 months
Frames
Once every 24 months
Contacts
Once every 12 months