Chipotle provides you two vision plan options to choose from. Both plans help with the cost of exams and glasses or lenses. The Buy-Up option provides an increased allowance for materials and a lower copay for exams.

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Vision Base Plan

In-Network

Eye Exam

Once every 12 months; Includes retinal imaging, up to provider limits

$20 copay

Standard Contact Lens Fit & Follow-Up

Up to $40 copay

Frames

Once every 24 months

$0 copay, $130 allowance
20% discount on balance over $130

Standard Plastic Lenses

Once every 12 months; Covers single, bifocal, trifocal, lenticular, and standard progressive lenses

$20 copay

Contact Lenses (instead of glasses)

Medically Necessary

$0 copay

Conventional

$300 materials allowance
15% off balance over $130

Disposable

$300 materials allowance

Your Bi-Weekly Cost for Coverage

You

$1.73

You + Spouse/Domestic Partner

$3.28

You + Child(ren)

$3.46

You + Family

$5.08

Anthem ASO

Phone: 855-653-4066

Web: anthem.com

vision