LAPRA 2018/19 Benefits Guide for Retired Members

12 Vision LAPRA members who enroll in the Anthem Blue Cross Prudent Buyer PPO or the Anthem Blue Cross CaliforniaCare Plus HMO automatically receive vision coverage through Vision Service Plan (VSP). You may use any vision provider for vision care; however, when you use a VSP Choice provider, you’ll save money on exams and eyewear and there are no claim forms. VSP also offers discounts on glasses and sunglasses, contact lenses, and laser vision correction. Most services are provided every 12 months. For more information and to find a member doctor, visit the VSP website at www.vsp.com . Vision Benefits for Kaiser HMO Members If you enroll in the Kaiser HMO, vision care is provided through Kaiser. There is no charge for eye exams to determine the need for vision correction. In addition, members receive a $350 allowance for medically necessary eyewear every 24 months. Benefit Feature Coverage from VSP Choice Network Provider Non-VSP Choice Network Reimbursement Amounts 1 Eye Exam Once every 12 months $20 co-pay $45 reimbursement Frames Once every 12 months Lenses Once every 12 months • Single vision lens • Lined bifocal lens • Lined trifocal lens Plan pays up to $115 (20% discount on out-of-pocket expense above $115) Plan pays 100% Plan pays 100% Plan pays 100% $47 reimbursement $45 reimbursement $65 reimbursement $85 reimbursement Contact Lenses & Fitting Exam Once every 12 months (in lieu of lenses and frames) $120 allowance $105 reimbursement 1 You must submit claim forms when you use non-VSP Choice Network providers.