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  • General
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  • Individuals and Families (2025)
  • Individuals and Families (2024)
  • Blue Solutions: Small Employer (2025)
  • Blue Solutions: Small Employer (2024)
  • Large Group Options 51-99 (2025)
    • POS
    • DPOS
    • Personal Choice/PPO
    • Rx-Freestanding/Rider
    • Vision
    • Dental
  • Large Group Options 51-99 (2024)
  • Large Group Options 100+ (2025)
  • Large Group Options 100+ (2024)

Vision Benefit SummariesGroups 51-992025

Forms are in pdf format.

$35 Eyewear Benefit
Vision Care 100: 12/12/12
Vision Care 100: 12/12/12-Voluntary
Vision Care 100: 12/12/24
Vision Care 100: 12/12/24-Voluntary
Vision Care 100: 24/24/24
Vision Care 130: 12/12/12
Vision Care 130: 12/12/12-Voluntary
Vision Care 130: 12/12/24
Vision Care 130: 12/12/24-Voluntary
Vision Care 130: 12/12/24 with Copay
Vision Care 130: 12/12/24 with copay - Voluntary
Vision Care 150: 12/12/12
Vision Care 150: 12/12/12-Voluntary
Vision Care 150: 12/12/24
Vision Care 150: 12/12/24-Voluntary

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Independence Blue Cross is a subsidiary of Independence Health Group, Inc. ‐ independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.