Vision - Horizon Blue Cross Blue Shield of New Jersey
Horizon Vista V
The Horizon Vista V plan includes an annual eye exam for $10, $100 reimbursement for frames or contact lens ― $150 for frames if a member uses a Visionworks retail locations. Clear plastic single-vision, lined bifocal, trifocals included. For additional information please call 1-844-826-5528.
| Covered Services | Coverage | Coverage Details |
|---|---|---|
| Eye examination once every 12 months | $10 Copayment |
|
| Frame | Up to $100 or $150 at Visionworks retail locations | |
| Single-vision, lined bifocal, trifocal or lenticular lenses | Included | |
| Progressive lenses (standard/premium/ultra) | $65/$105/$140 | |
| Ultraviolet coating | $15 | |
| High index lenses /plastic photochromic lenses /polarized lenses | $60/$70/$75 | |
| Non-collection contact lenses | Up to $100 |
Horizon Panorama V
The Horizon Panorama V is an advanced plan which includes an annual eye exam for $10, $130 reimbursement for frames or contact lens ― $180 for frames if a member uses a Visionworks retail locations. Clear plastic single-vision, lined bifocal, trifocals included. For additional information please call 1-844-826-5528.
| Covered Services | Coverage | Coverage Details |
|---|---|---|
| Eye examination once every 12 months | $10 Copayment |
|
| Frame | Up to $130 or $180 at Visionworks retail locations | |
| Single-vision, lined bifocal, trifocal or lenticular lenses | Included | |
| Progressive lenses (standard/premium/ultra) | $50/$90/$140 | |
| Ultraviolet coating | $12 | |
| High index lenses /plastic photochromic lenses/polarized lenses | $55/$65/$75 | |
| Non-collection contact lenses | Up to $130 | |
| Collection contact lenses disposable Planned replacement |
Up to 4 boxes/multi-packs Up to 2 boxes/multi-packs |
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