Summary of Benefits 2026 – Vision

The following Summary of Benefits (SOB) 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, 1 MB)

2026 Vision Summary of Benefits

Vision plan name Summary of Benefits Disclosures
Vision Deluxe 0/0/130 English (PDF, 740 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus 0/0/130 English (PDF, 740 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus 0/25/130 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Deluxe 0/25/130 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Deluxe with Contacts 0/0/150/150 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Deluxe 0/0/150 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Deluxe with Contacts 15/25/150/150 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Deluxe 15/25/150 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Deluxe 15/25/130 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus with Contacts 0/0/150/150 English (PDF, 740 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus 0/0/150 English (PDF, 740 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus with Contacts 15/25/150/150 English (PDF, 740 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus 15/25/150 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus 15/25/130 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus 10/25/150 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus with Contact Lens and Fitting 10/25/150/150 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Deluxe 10/25/150 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Deluxe with Contact Lens and Fitting 10/25/150/150 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus with Contact Lens and Fitting 10/25/130/130 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus 10/25/130 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Deluxe 10/25/130 English (PDF, 728 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Deluxe 10/25/150/150 English (PDF, 728 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Eye Exam Only English (PDF, 728 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)

 

 

Voluntary Vision plans Summary of Benefits Disclosures
Vision Deluxe Voluntary 10/25/130 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Deluxe Voluntary 15/25/150 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus Voluntary 10/25/130 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus Voluntary 15/25/130 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)

 

 

Not Marketed Vision Plans Summary of Benefits Disclosures
Vision Standard 0/0/75 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard 0/0/130 English (PDF, 740 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard 0/25/100 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard 0/25/130 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus 0/15/130 English (PDF, 740 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Deluxe 0/15/130 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard 0/0/100 English (PDF, 741 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Deluxe 0/0/120 English (PDF, 740 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Deluxe 15/25/120 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus 0/0/120 English (PDF, 740 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus Voluntary 15/25/120 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus 15/25/120 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard with Contacts 0/0/150/150 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard 0/0/150 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard 0/0/120 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard with Contacts 15/25/150/150 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard 15/25/150 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard Voluntary 15/25/120 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard 15/25/130 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard 15/25/120 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard Voluntary 10/25/130 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard 10/25/120 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard 10/25/150 English (PDF, 740 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Standard with Contact Lens and Fitting 10/25/150/150 English (PDF, 740 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Plus 10/25/120 English (PDF, 743 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)
Vision Deluxe 10/25/120 English (PDF, 742 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 808 KB)

2026 Materials Only Vision Plan

Plan name Summary of Benefits Disclosures
Vision Standard Materials only -/15/120 English (PDF, 242 KB)
Spanish (PDF, coming soon)
Disclosure (PDF, 380 KB)

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