Table of Contents Important Information..................................................................................................................4 Important Notices..........................................................................................................................6 Eligibility - Effective Date.............................................................................................................8 How to Find a Cigna Vision Provider and File a Claim...........................................................10 Cigna Vision.................................................................................................................................11 The Schedule..........................................................................................................................................................11 Covered Expenses........................................................................................................................14 Exclusions .....................................................................................................................................14 Coordination of Benefits..............................................................................................................15 Expenses For Which A Third Party May Be Responsible.......................................................16 Payment of Benefits.....................................................................................................................17 Termination of Insurance............................................................................................................18 Federal Requirements.................................................................................................................19 Notice of Provider Directory/Networks.................................................................................................................19 Qualified Medical Child Support Order (QMCSO)...............................................................................................19 Group Plan Coverage Instead of Medicaid............................................................................................................21 Requirements of Family and Medical Leave Act of 1993 (as amended) (FMLA)................................................21 Uniformed Services Employment and Re-Employment Rights Act of 1994 (USERRA).....................................21 Claim Determination Procedures under ERISA....................................................................................................21 Appointment of Authorized Representative..........................................................................................................22 Vision - When You Have a Complaint or an Appeal............................................................................................22 COBRA Continuation Rights Under Federal Law................................................................................................24 ERISA Required Information................................................................................................................................27 Miscellaneous................................................................................................................................29 Definitions .....................................................................................................................................30
HCVIS-TOC0
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