Vision

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Introduction: Your Vision Plan is administered by Anthem Blue View Vision. You can receive care from any licensed eye care professional, but if you see an Anthem in-network provider, you receive a higher level of benefits and there are no claim forms to file. To find a provider, visit www.anthem.com. ID cards are provided for this plan. Vision coverage is included on your Anthem medical ID card, if you are enrolled in the Health Plan as well.

Vision Plan Coverage Chart

Vision Plan – Anthem Blue View Vision
Plan Features	In-Network	Out-of-Network
Frequency of Service Exams Lenses/Contacts Frames	Once every calendar year Once every calendar year Once every other calendar year	Once every calendar year Once every calendar year Once every other calendar year
Cost of Services Exams Frames Lenses Single Vision Bifocal Trifocal Contacts (in lieu of prescription eyeglass lenses)	No copay No copay (up to $130 retail) $10 copay $10 copay $10 copay Up to a maximum allowance of $130. This benefit applies to one order of contact lenses per calendar year.	Up to a maximum allowance of $35 Up to a maximum allowance of $45 Up to a maximum allowance of $25 Up to a maximum allowance of $40 Up to a maximum allowance of $55 Up to a maximum allowance of $105. This benefit applies to one order of contact lenses per calendar year.

Vision Plan Rates for Active Employees

2020 Vision Plan Monthly Employee Contributions (pre-tax payroll deductions)
	Employee Only	Employee + Spouse	Employee + Children	Employee + Family
Vision Plan	$7.00	$12.00	$13.00	$20.00

Vision Plan Rates for Pre-65 Retirees

Retirees under age 65 are eligible for the same vision coverage as MPC active employees.

^* This Plan is not open to new enrollment. Please check with the Benefits Service center on your eligibility.

Pre-65 Retiree Vision Plan – 2020 Monthly Contributions
	Retiree Only	Retiree + Spouse	Retiree + Children	Retiree + Family
Vision Plan	$7.00	$12.00	$13.00	$20.00

More Important Information

Phone: 1-888-421-2199
Monday through Friday,
8 a.m. to 5 p.m.,
Eastern Standard Time
Email: benefits@marathonpetroleum.com
Fax: 1-419-421-3057
539 S. Main St.
Findlay, OH 45840
D-03-105