Cigna Vision Plan
Services
In-Network
Out-of-Network
Exam (Once Every Calendar Year)
$10 copay
Up to $45 Reimbursement
Lenses (Once Every Calendar Year)
$20 Copay
Single
$20 Copay
Up to $32 Reimbursement
Bifocal
$20 Copay
Up to $55 Reimbursement
Trifocal
$20 copay
Up to $65 Reimbursement
Lenticular
$20 Copay
Up to $80 Reimbursement
Contact Lenses (Once Every Calendar Year)
100% up to $130 Allowance
Up to $105 Reimbursement
Elective
Covered 100%
Up to $210 Reimbursement
Medically Necessary
Frames (Once Every Calendar Year)
Up to $71 Reimbursement
20% off balance over $130 Allowance
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