Cigna Vision
Benefits
In-Network
Out-of-Network
Eye Exam
$10 copay
n/a
Materials
n/a
Plan pays up to $45
Single Vision Lenses
$20 copay
Plan pays up to $32
Bifocal Lenses
$20 copay
Plan pays up to $55
Trifocal Lenses
$20 copay
Plan pays up to $65
Lenticular Lenses
$20 copay
Plan pays up to $80
Frames
$130 allowance
Plan pays up to $71
Contact Lenses Elective
$130 allowance
Plan pays up to $105
Contact Lenses Medically Necessary
covered in full
Plan pays up to $210
Dependent Cut Off Age
26 years old
Frequency is 1 per calendar year for exams, lenses or contact lenses, and frames.
2024-2025 Benefit Summary
15
Made with FlippingBook - PDF hosting