Introducing FEP BlueVision  
   

Welcome to FEP BlueVision 2010!
BlueCross® and BlueShield® has been working for more than 46 years to bring you exceptional coverage at affordable prices. This year we have reduced member premiums while increasing the benefits offered to you and your eligible family members! FEP BlueVision continues to deliver the high quality and great value you have come to expect from us. As an FEP BlueVision member you will enjoy:

Full array of covered-in-full benefits at network providers:

  • Annual routine eye health & vision exam
  • Standard eyeglass lenses in any prescription range
  • Many add-on lens options
  • Any frame from FEP BlueVision's exclusive Collection, or $130 allowance toward any other frame
  • For contact lenses (in lieu of eyeglasses), $130 allowance

Specialized Nationwide Network:

  • Extensive network of over 27,000 credentialed ophthalmologists and optometrists, plus many national and regional locations

Significant cost savings on:

  • Lens options not fully covered by FEP BlueVision
  • Contact lens replacements
  • Laser correction surgery

You'll get complete eye care coverage at a great value. Sign up for FEP BlueVision now!
This is a summary of the many benefits and features of FEP BlueVision. For a complete description, please refer to the benefit brochure.

FEP BlueVision Benefit Summary
  Standard Option High Option
Frequency
(once per)
Exam 12 Months
Lenses 12 Months
Frames 24 Months
Exam 12 Months
Lenses 12 Months
Frames 12 Months
Biweekly Premium
(Pre-tax for Actives)
Self Only $3.92
Self Plus One $7.84
Self and Family $11.76
Self Only $4.92
Self Plus One $9.84
Self and Family $14.76
Monthly Premium
(Post-tax for Annuitants)
Self Only $8.49
Self Plus One $16.99
Self and Family $25.48
Self Only $10.66
Self Plus One $21.32
Self and Family $31.98
Eye Examination No copayment No copayment
Spectacle Lenses No copayment No copayment
Includes choice of glass or plastic lenses, all lens powers (single vision, bifocal, trifocal, lenticular), fashion and gradient tinting, oversized and glass-grey #3 prescription sunglass lenses, and scratch resistant coating*.  Polycarbonate lenses are covered in full for children, monocular patients and patients with prescriptions >= +/- 6.00 diopters.  And, for High Option, standard progressive lenses are covered in full. 
Optional Lens Treatments Available at significant savings. Please see below for copayments. Available at significant savings. Please see below for copayments.
Frame Member pays nothing for frames from the FEP BlueVision exclusive Collection (with retail values of up to $225) OR receives allowance up to $130 once every two calendar years toward any provider supplied frame, plus 20% off charges over $130**. Member pays nothing for frames from the FEP BlueVision exclusive Collection (with retail values of up to $225) OR receives allowance up to $130 once every calendar year toward any provider supplied frame, plus 20% off charges over $130**.
Eyeglass Warranty FEP BlueVision Collection frames and all spectacle lenses manufactured in FEP BlueVision laboratories are guaranteed for a period of one (1) year from the original date of dispensing***. FEP BlueVision Collection frames and all spectacle lenses manurfactured in FEP BlueVision laboratories are guaranteed for a period of one (1) year from the original date of dispensing***.
Contact Lens(es) - initial order
(in lieu of eyeglasses)		 Member receives an allowance up to $130 per calendar year toward contact lenses, fitting and evaluation fees,  plus 15% off charges over $130**. Member receives an allowance up to $130 per calendar year  toward contact lenses, fitting and evaluation fees,  plus15% off charges over $130**.
Replacement Contact Lenses Members receives significant savings on replacement contact lenses with the guaranteed lowest price. Call 800-536-7123 or visit www.lens123.com Members receives significant savings on replacement contact lenses with the guaranteed lowest price. Call 800-536-7123 or visit www.lens123.com
Laser Vision Up to 25% off Provider's Usual and Customary price or 5% off promotional pricing. (To ensure that the discount is applied correctly, the member must obtain pre-authorization for this service. Contact 888-550-2583.) Up to 25% off Provider's Usual and Customary price or 5% off promotional pricing. (To ensure that the discount is applied correctly, the member must obtain pre-authorization for this service. Contact 888-550-2583.)

Optional Lens Treatments
Description Retail Value Member Prices Savings
Ultraviolet Coating $25-$30 $12 $13-$18
Polycarbonate Lenses**** $60-$75 $0 or $30 Up to $75
Blended Segment Lenses $40-$50 $20 $20-$30
Intermediate Vision Lenses $150-$175 $30 $120-$145
Standard Progressive Addition Lenses $150-$195 Standard Option Plan: $50
High Option Plan: $0 		$100-$195
Premium Progressive Addition Lenses (Varilux®, etc.) $195-$300 $90 $105-$210
Photochromic Glass Lenses $30-$60 $20 $10-$40
Plastic Photosensitive Lenses (Transitions®) $95-$150 $65 $30-$85
Polarized Lenses $95-$110 $75 $20-$35
Standard Anti-Reflective (AR) Coating $50-$70 $35 $15-$35
Premium AR Coating $65-$90 $48 $17-$42
Ultra AR Coating $100-$125 $60 $40-$65
Hi-Index Lenses $90-$150 $55 $35-$95

Out-of-Network Reimbursement (for High Option only)
Eye Examination Up to $30              Spectacle Lenses  
Frame Up to $30    -Single Vision Lenses Up to $25
Elective Contact Lenses Up to $75    -Bifocal Lenses Up to $35
Medically Necessary Contact Lenses Up to $225    -Trifocal Lenses Up to $45
* At Walmart, there may be an additional charge for scratch resistant coating.
** At Walmart locations, additional discounts are not applicable.
*** Warranty limitations may apply to provider- or retailer-supplied frames and/or spectacle lenses; see provider for details.
**** Polycarbonate lenses are covered in full for dependent children, monocular patients and patients with prescriptions > = +/- 6.00 diopters.

To learn more about how to enroll, call: 1.888.550.BLUE (2583) or visit www.fepblue.org

Note: This is a summary of the many features and benefits of FEP BlueVision. For a complete description, please refer to your benefit brochure.