Table of Contents Important Information..................................................................................................................4 Important Notices..........................................................................................................................6 How to Find a Cigna Vision Provider and File a Claim.............................................................8 Eligibility - Effective Date.............................................................................................................9 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............................................................................................................19 Miscellaneous................................................................................................................................19 Definitions .....................................................................................................................................20 Federal Requirements.................................................................................................................25 Notice of Provider Directory/Networks.................................................................................................................25 Qualified Medical Child Support Order (QMCSO)...............................................................................................25 Group Plan Coverage Instead of Medicaid............................................................................................................26 Requirements of Family and Medical Leave Act of 1993 (as amended) (FMLA)................................................27 Uniformed Services Employment and Re-Employment Rights Act of 1994 (USERRA).....................................27 Claim Determination Procedures under ERISA....................................................................................................27 Appointment of Authorized Representative..........................................................................................................28 Vision - When You Have a Complaint or an Appeal............................................................................................28 COBRA Continuation Rights Under Federal Law................................................................................................30 ERISA Required Information................................................................................................................................33
HCVIS-TOC0
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