J & L Ventures, LLC - Benefit Guide 2021 - 2022 Plan Year

Vision Coverage

The vision plan covers routine eye exams and also pays for all or a portion of the cost of glasses or contact lenses if you need them.

Your PPO vision plan is through Anthem BlueCross BlueShield and offers “in and out-of-network” benefits.

To find an in-network provider, visit bcbsga.com

Insurance Carrier:

Anthem BlueCross BlueShield Vision Insurance

Plan Type:

Blue ViewVision

In-Network $10 Copay $20 Copay $20 Copay $20 Copay

Out-of-Network $30 allowance $25 allowance $40 allowance $55 allowance

Exam Services

Lenses - Single lined Lenses - Bifocal lined

Lenses - Trifocal

$ 130 allowance; then 15% off any remaining balance

Contacts / Lenses

$105 allowance

$130 allowance; then 20% off any remaining balance

Frames

$45 allowance

Frequency for Exam / Lenses / Frames Employee Bi-Weekly Deduction Employee Only

12 months / 12 months / 24 months

$1.65 $2.76 $2.52 $4.46

Employee + Spouse Employee + Child(ren)

Family

7 J&L Ventures, LLC 2022 Enrollment Guide

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