MAA 2021 Benefits Guide

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Frequency (Begins Jan 1)

Benefit

In-Network

Out-of-Network

You pay $10 Copay plan pays remainder

Eye Exam

Up to $45 reimbursement

12 months

Materials Copay

$20 Copay

n/a

12 months

Eyeglass Lenses Allowances: (One pair per frequency period)

• Single Vision • Lined Bifocal • Lined Trifocal • Progressive • Lenticular

Plan pays 100% after copay Plan pays 100% after copay Plan pays 100% after copay Plan pays 100% after copay Plan pays 100% after copay Plan pays up to $150 20% discount on amount over allowance

Up to $40 reimbursement Up to $65 reimbursement Up to $75 reimbursement Up to $75 reimbursement Up to $100 reimbursement

12 months 12 months 12 months 12 months 12 months

Frame Retail Allowance* (One pair per frequency period) Contact Lens Allowance* (One pair or single per frequency period)

Up to $83 reimbursement

24 months

• Elective • Therapeutic 12 months 12 months *Contact Lens Allowance in lieu of Frame Allowance (may not receive contact lens and frames in same benefit year). Plan pays up to $130 Plan pays 100% Up to $105 reimbursement Up to $210 reimbursement

2021 Bi-Weekly Associate Payroll Contributions by Coverage Level Employee Only $2.90 Employee + Spouse $5.79 Employee + Child(ren) $6.22 Employee + Family $9.85

Click here for the benefit summary for the Cigna Vision Plan.

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