Usual Fee The fee that an individual Vision Provider most frequently charges for a given vision service.
Policyholder The term Policyholder means the owner of the group Policy as identified on the certification page.
HCVIS-DFS54
01-24
HCVIS-DFS48
01-24
Vision Materials The term Vision Materials means those materials provided for visual health and welfare shown in the Schedule of Benefits.
Qualified Medical Child Support Order A Qualified Medical Child Support Order is a judgment, decree or order (including approval of a settlement agreement) or administrative notice, which is issued pursuant to a state domestic relations law (including a community property law), or to an administrative process, which provides for child support or provides for health benefit coverage to such child and relates to benefits under the group health plan, and satisfies all of the following: • the order recognizes or creates a child’s right to receive group health benefits for which a participant or beneficiary is eligible; • the order specifies Your name and last known address, and the child’s name and last known address, except that the name and address of an official of a state or political subdivision may be substituted for the child’s mailing address; • the order provides a description of the coverage to be provided, or the manner in which the type of coverage is to be determined; • the order states the period to which it applies; and • if the order is a National Medical Support Notice completed in accordance with the Child Support Performance and Incentive Act of 1998, such notice meets the requirement above.
HCVIS-DFS55
01-24
Vision Provider The term Vision Provider means: an optometrist, ophthalmologist, optician or a group partnership or other legally recognized aggregation of such professionals; duly licensed and in good standing with the relevant public licensing bodies to provide covered vision services within the scope of the Vision Providers’ respective licenses.
HCVIS-DFS56
01-24
We, Us and Our The terms We, Us and Our mean Cigna Health and Life Insurance Company.
HCVIS-DFS57
01-24
You, Your, Yourself The Employee and/or any of his/her Dependents.
HCVIS-DFS49
01-24
HCVIS-DFS58
01-24
Spouse The term Spouse means Your legally recognized Spouse in the state where You reside.
HCVIS-DFS52
01-24
myCigna.com
24
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