VISION BENEFITS
FREQUENCY (Begins on January 1)
benefit
in-network
out-of-network
You pay a $10 Copay, plan pays the rest $20 Copay
Up to $45 reimbursement n/a
12 months
Eye Exam Materials Copay
12 months
Eyeglass Lenses Allowances: (one pair per frequency period)
Play pays 100% after copay Play pays 100% after copay Play pays 100% after copay Play pays 100% after copay Play pays 100% after copay Plan pays up to $150, 20% discount on amount over allowance
• Single Vision • Lined Bifocal • Lined Trifocal • Progressive • Lenticular
12 months 12 months 12 months 12 months 12 months
Up to $40 reimbursement Up to $65 reimbursement Up to $75 reimbursement Up to $75 reimbursement Up to $100 reimbursement Up to $83 reimbursement
Frame Retail Allowance (one per frequency period)
24 months
Contact Lens Allowance* (one pair or single purchase per frequency period) • Elective • Therapeutic
12 months 12 months
Plan pays up to $130 Plan pays 100%
Up to $105 reimbursement Up to $210 reimbursement
* Contact Lens Allowance in lieu of Frame Allowance (may not receive contact lenses and frames in same benefit year).
2018 bi-weekly associate payroll contributions by coverage level
EMPLOYEE CONTRIBUTION $2.49 $4.98 $5.35 $8.47
Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
plan link
Click here for the benefits summary for the Cigna Vision Plan
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