ÀǘȪǘȅǻǯƎǻ 1%%SJJIVWEGSQTVILIRWMZIZMWMSRTPERXLVSYKL'MKRE8LITPERSJJIVW]SYXLIƽI\MFMPMX]XSWIII]I care professionals in or out of Cigna’s network. However, when you receive care in-network, your costs are lower. When you see an eye care professional outside the network, you will pay in full at XLIXMQISJWIVZMGIERHƼPIEGPEMQXS'MKREJSVVIMQFYVWIQIRX YTXSXLIEQSYRXWPMWXIHFIPS[
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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