(Begins on January 1)
You pay a $10 Copay, plan pays the rest
Up to $45 reimbursement
Eye Exam
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
12 months 12 months 12 months 12 months 12 months
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
Frame Retail Allowance* (One per frequency period)
Up to $83 reimbursement
24 months
Contact Lens Allowance* (One pair or single per frequency period) Elective Therapeutic
Plan pays up to $130 Plan pays 100%
Up to $105 reimbursement Up to $210 reimbursement
12 months 12 months
* Contact Lens Allowance in lieu of Frame Allowance (may not receive contact lenses and frames in same benefit year).
Employee Only
$2.63
Employee + Spouse
$5.26
Employee + Child(ren)
$5.65
Employee + Family
$8.95
Click here for the benefit summary for the Cigna Vision Plan.
Made with FlippingBook Annual report