Blue View Plus PlanSUMMARY OF FEATURES

This is an overview of coverage. Please refer to the Exclusions and Limitations in the Blue View Vision brochure for additional plan provisions. Please review the Exclusions and Limitations prior to applying for coverage. A comprehensive description of coverage, benefits, and limitations is contained in the Certificate.

BLUE VIEW PLUS PLAN

*Coverage for this PPO vision plan includes choice of frames and lenses OR contacts, not both.

** Non-elective contacts are those prescribed following cataract surgery or for extreme visual acuity or other functional problems not treatable by spectacle lens.

Using Your Blue View Plus Plan

Anthem Blue Cross Life and Health Insurance Company understands that vision benefits are essential to maintaining your overall health and wellness, and we are committed to your vision care. Through your Blue View plan, not only do you have access to 4,500 providers and provider locations (including a market-leading number of independent ophthalmologists and optometrists), but you also get the convenience of LensCraftersSM,Target Optical, Sears Optical, and most Pearle Vision stores. Many of the providers are open in the evenings and on weekends, so you have the flexibility to schedule an appointment that allows you less time away from work.

Members can save with their covered benefit and long after their benefits have been exhausted. Members will enjoy a 20% discount off any remaining balance for frames purchased over the frame allowance. And they can save 15 to 40% on non-covered materials such as additional pairs of glasses, conventional contact lenses, lens treatments, some non-prescription sunglasses and other accessory items. Members can access this savings from any participating provider as often as they choose.

You simply choose a Blue View Vision network eye care provider, make an appointment, present your membership card, pay your eye examination copayment and any remaining balance. The provider will verify your eligibility and take care of all the necessary paperwork. To select an eye care provider or location, you can access the Provider Directory on www.anthem.com/ca or call Customer Service at (866) 723-0515.

Anthem Blue Cross Life and Health Insurance Company is an independent licensee of the Blue Cross Association. ® ANTHEM is a registered trademark. ® The Blue Cross name and symbol are registered marks of the Blue Cross Association.ECASB2246BEN 4/08

Eye Examination Lenses EveryContact Lenses* FramesIn-Network CopaymentEYE EXAMINATION COPAYIn-Network BenefitsEYE EXAMINATION LENSES (Standard) Single vision

Bifocal lenses

Progressive lenses

Trifocal lenses

FRAME CONTACT LENSES ElectiveConventional

Disposable

Non-elective** ADDITIONAL DISCOUNTS Out-of-Network ReimbursementEYE EXAMINATION LENSES (Standard)Single vision

Bifocal lenses

Progressive lenses

Trifocal lenses

FRAMECONTACT LENSESElectiveConventional

Disposable

Non-elective**

Every 12 months

Every 12 months

Every 12 months

Every 12 months

$15

Covered up to a comprehensive level exam with dilation as necessary after exam copay

Plastic lenses in single vision, bifocal, or trifocal

Covered in full after exam copay

Covered in full after exam copay

Covered in full after exam copay + $65

Covered in full after exam copay

Covered up to $120 retail value after exam copay.Members receive a 20% discount on the

amount over the allowance

Benefit allowance applies to fit, follow-up & materials

Conventional Covered up to $115 allowance after examcopay. 15% off balance over allowance

Covered up to $115 allowance after exam copay

Covered in full after exam copay

Discounts available from Participating Providers

Reimbursed up to $49

Reimbursed up to $35

Reimbursed up to $49

Reimbursed up to $49

Reimbursed up to $74

Reimbursed up to $50

Reimbursed up to $92

Reimbursed up to $92

Reimbursed up to $250

Blue View Plus