2022 Benefit Summaries | Vision Highlights | Vision network at a glance | Benefit solutions | Vision Plans
For California members – English | For California members – Spanish
The following benefit summaries are for groups of 101 or more employees.
When providing a benefit summary to an applicant or Blue Shield member, you must also include a Notice of Language Assistance. (PDF, 1MB)
Vision Plan Name | Summary of Benefits | Disclosure |
---|---|---|
Vision Deluxe 0/0/120 | English 740KB Spanish 787KB | Disclosure 808KB |
Vision Deluxe 0/0/130 | English 740KB Spanish 787KB | Disclosure 808KB |
Vision Deluxe 0/0/150 | English 742KB Spanish 790KB | Disclosure 808KB |
Vision Deluxe 0/25/130 | English 742KB Spanish 787KB | Disclosure 808KB |
Vision Deluxe 10/25/120 | English 742KB Spanish 789KB | Disclosure 808KB |
Vision Deluxe 10/25/150 | English 742KB Spanish 790KB | Disclosure 808KB |
Vision Deluxe 15/25/120 | English 742KB Spanish 789KB | Disclosure 808KB |
Vision Deluxe 15/25/130 | English 742KB Spanish 790KB | Disclosure 808KB |
Vision Deluxe 15/25/150 | English 743KB Spanish 790KB | Disclosure 808KB |
Vision Deluxe with Contacts 0/0/150/150 | English 742KB Spanish 788KB | Disclosure 808KB |
Vision Deluxe with Contacts 15/25/150/150 | English 743KB Spanish 791KB | Disclosure 808KB |
Vision Deluxe with Contact Lens and Fitting 10/25/150/150 | English 742KB Spanish 791KB | Disclosure 808KB |
Vision Plus 0/0/120 | English 740KB Spanish 787KB | Disclosure 808KB |
Vision Plus 0/0/130 | English 740KB Spanish 787KB | Disclosure 808KB |
Vision Plus 0/0/150 | English 740KB Spanish 788KB | Disclosure 808KB |
Vision Plus 0/25/130 | English 742KB Spanish 791KB | Disclosure 808KB |
Vision Plus 10/25/120 | English 743KB Spanish 789KB | Disclosure 808KB |
Vision Plus 10/25/130 | English 743KB Spanish 789KB | Disclosure 808KB |
Vision Plus 10/25/150 | English 743KB Spanish 791KB | Disclosure 808KB |
Vision Plus 15/25/120 | English 743KB Spanish 789KB | Disclosure 808KB |
Vision Plus 15/25/130 | English 743KB Spanish 791KB | Disclosure 808KB |
Vision Plus 15/25/150 | English 743KB Spanish 791KB | Disclosure 808KB |
Vision Plus with Contacts 0/0/150/150 | English 740KB Spanish 788KB | Disclosure 808KB |
Vision Plus with Contacts 15/25/150/150 | English 740KB Spanish 791KB | Disclosure 808KB |
Vision Plus with Contact Lens and Fitting 10/25/130/130 | English 743KB Spanish 792KB | Disclosure 808KB |
Vision Plus with Contact Lens and Fitting 10/25/150/150 | English 743KB Spanish 792KB | Disclosure 808KB |
Vision Standard 10/25/120 | English 743KB Spanish 780KB | Disclosure 808KB |
Vision Standard 10/25/150 | English 740KB Spanish 791KB | Disclosure 808KB |
Vision Standard 0/0/120 | English 742KB Spanish 788KB | Disclosure 808KB |
Vision Standard 0/0/130 | English 740KB Spanish 787KB | Disclosure 808KB |
Vision Standard 0/0/150 | English 742KB Spanish 788KB | Disclosure 808KB |
Vision Standard 0/25/130 | English 743KB Spanish 791KB | Disclosure 808KB |
Vision Standard 15/25/120 | English 743KB Spanish 791KB | Disclosure 808KB |
Vision Standard 15/25/130 | English 743KB Spanish 791KB | Disclosure 808KB |
Vision Standard 15/25/150 | English 743KB Spanish 791KB | Disclosure 808KB |
Vision Standard with Contacts 0/0/150/150 | English 742KB Spanish 790KB | Disclosure 808KB |
Vision Standard with Contacts 15/25/150/150 | English 743KB Spanish 791KB | Disclosure 808KB |
Vision Standard with Contact Lens and Fitting 10/25/150/150 | English 740KB Spanish 791KB | Disclosure 808KB |
Eye Exam Only | English 728KB Spanish 763KB | Disclosure 808KB |
Voluntary Vision Plans | Summary of Benefits | Disclosures |
---|---|---|
Vision Deluxe Voluntary 10/25/130 | English 742KB Spanish 791KB | Disclosure 808KB |
Vision Deluxe Voluntary 15/25/150 | English 742KB Spanish 790KB | Disclosure 808KB |
Vision Plus Voluntary 10/25/130 | English 743KB Spanish 791KB | Disclosure 808KB |
Vision Plus Voluntary 15/25/120 | English 743KB Spanish 790KB | Disclosure 808KB |
Vision Standard Voluntary 10/25/130 | English 743KB Spanish 791KB | Disclosure 808KB |
Vision Standard Voluntary 15/25/120 | English 743KB Spanish 790KB | Disclosure 808KB |
Not Marketed Vision Plans | Summary of Benefits | Disclosure |
---|---|---|
Vision Plus 10/0/100 | English 740KB Spanish 787KB | Disclosure 808KB |
Vision Standard 0/0/75 | English 742KB Spanish 787KB | Disclosure 808KB |
Vision Standard 10/0/100 | English 742KB Spanish 787KB | Disclosure 808KB |
Vision Standard 0/25/100 | English 742KB Spanish 789KB | Disclosure 808KB |
Vision Standard 0/15/120 | English 743KB Spanish 791KB | Disclosure 808KB |
Vision Standard 0/15/130 | English 743KB Spanish 791KB | Disclosure 808KB |
Vision Plus 0/25/120 | English 742KB Spanish 789KB | Disclosure 808KB |
Vision Plus 0/15/130 | English 740KB Spanish 780KB | Disclosure 808KB |
Vision Deluxe 0/15/130 | English 742KB Spanish 790KB | Disclosure 808KB |
Vision Standard 0/0/100 | English 741KB Spanish 787KB | Disclosure 808KB |
Plan Name | Summary of Benefits | Disclosures |
---|---|---|
Vision Standard Materials only -/15/120 | Disclosure 380KB |
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