Summary of Benefits 2024 - Vision

Summary of Benefits

When providing a summary of benefits to an applicant or Blue Shield member, you must also include a Disclosure and a Notice of Language Assistance. (PDF, 1.1MB)

How to read plan names: Eye exam copayment/materials copayment/frame allowance. 'Plus' plans include additional benefits for contact lens materials and fitting.

Basic plans

Plan names Summaries of Benefits Disclosures
Basic Vision for Small Business 0/0/120 English
Spanish
English
Basic Vision for Small Business 0/0/150 English
Spanish
English
Basic Vision for Small Business 10/25/120 English
Spanish
English
Basic Vision for Small Business 10/25/150 English
Spanish
English
Basic Vision Plus for Small Business 0/0/150/150 English
Spanish
English
Basic Vision Plus for Small Business 10/25/150/150 English
Spanish
English
Basic Vision Voluntary for Small Business 10/25/120 English
Spanish
English

Preferred plans

Plan names Summaries of Benefits Disclosure
Preferred Vision for Small Business 0/0/120 English
Spanish
English
Preferred Vision for Small Business 0/0/150 English
Spanish
English
Preferred Vision for Small Business 10/25/120 English
Spanish
English
Preferred Vision for Small Business 10/25/150 English
Spanish
English
Preferred Vision Plus for Small Business 0/0/150/150 English
Spanish
English
Preferred Vision Plus for Small Business 10/25/150/150 English
Spanish
English
Preferred Vision Voluntary for Small Business 10/25/120 English
Spanish
English

Ultimate plans

Plan names Summaries of Benefits Disclosure
Ultimate Vision for Small Business 0/0/120 English
Spanish
English
Ultimate Vision for Small Business 0/0/150 English
Spanish
English
Ultimate Vision for Small Business 10/25/120

English
Spanish
English
Ultimate Vision for Small Business 10/25/150

English
Spanish
English
Ultimate Vision Plus for Small Business 0/0/150/150

English
Spanish
English
Ultimate Vision Plus for Small Business 10/25/150/150 English
Spanish
English
Ultimate Vision Voluntary for Small Business 10/25/150

English
Spanish
English

Closed Vision plans - 2024: for renewing groups only

Plan names Summaries of Benefits Disclosure
Ultimate Vision for Small Business 15/25/120
English
Spanish
English
Ultimate Vision Plus for Small Business 15/25/150/150 English
Spanish
English
Ultimate Vision Voluntary for Small Business 15/25/150
English
Spanish
English
Ultimate Vision for Small Business 15/25/150
English
Spanish
English
Preferred Vision Plus for Small Business 15/25/150/150
English
Spanish
English
Preferred Vision Voluntary for Small Business 15/25/120
English
Spanish
English
Preferred Vision for Small Business 15/25/120
English
Spanish
English
Preferred Vision for Small Business 15/25/150 English
Spanish
English
Basic Vision for Small Business 15/25/120 English
Spanish
English
Basic Vision for Small Business 15/25/150 English
Spanish
English
Basic Vision Plus for Small Business 15/25/150/150 English
Spanish
English
Basic Vision Voluntary for Small Business 15/25/120 English
Spanish
English

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