2020 Ben Sum VIS_01.01.2020_Mid-America Apartments, L.P._33…

Mid-America Apartments, L.P. C1 - Standard PPO Comprehensive Plan

 One frame for prescription lenses – frame of choice covered up to retail plan allowance, plus a 20% savings on amount that exceeds frame allowance;  One pair of contact lenses or a single purchase of a supply of contact lenses – in lieu of lenses and frame benefit, (may not receive contact lenses and frames in same benefit year). Allowance applied towards cost of supplemental contact lens professional services (including the fitting and evaluation) and contact lens materials

* Provider participation is 100% voluntary; please check with your Eye Care Professional for any offered discounts.

Coverage for Therapeutic contact lenses will be provided when visual acuity cannot be corrected to 20/70 in the better eye with eyeglasses and the fitting of the contact lenses would obtain this level of visual acuity; and in certain cases of anisometropia, keratoconus, or aphakis; as determined and documented by your Vision eye care professional. Contact lenses fitted for other therapeutic purposes or the narrowing of visual fields due to high minus or plus correction will be covered in accordance with the Elective contact lens coverage shown on the Schedule of Benefits. Healthy Rewards® - Vision Network Savings Program:  When you see a Cigna Vision Network Eye Care Professional*, you can save 20% (or more) on additional frames and/or lenses, including lens options, with a valid prescription. This savings does not apply to contact lens materials. See your Cigna Vision Network Eye Care Professional for details.  Any eye examination, or any corrective eyewear, required by an employer as a condition of employment  Any injury or illness when paid or payable by Workers’ Compensation or similar law, or which is work-related  Charges in excess of the usual and customary charge for the Service or Materials  Charges incurred after the policy ends or the insured’s coverage under the policy ends, except as stated in the policy  Experimental or non-conventional treatment or device  Magnification or low vision aids not shown as covered in the Schedule of Vision Coverage  Any non-prescription (minimum Rx required) eyeglasses, includes frame, lenses, or contact lenses  Spectacle lens treatments, “add-ons”, or lens coatings not shown as covered in the Schedule of Vision Coverage  Prescription sunglasses  Two pair of glasses, in lieu of bifocals or trifocals  Safety glasses or lenses required for employment not shown as covered in the Schedule of Vision Coverage  VDT (video display terminal)/computer eyeglass benefit  Claims submitted and received in excess of twelve (12) months from the original Date of Service What’s Not Covered:  Orthoptic or vision training and any associated supplemental testing  Medical or surgical treatment of the eyes

How to use your Cigna Vision Benefits

(Please be aware that the Cigna Vision network is different from the networks supporting our health/medical plans).

1. Finding a doctor There are three ways to find a quality eye doctor in your area: 1. Log into myCigna.com,”Coverage”, select Vision page. Click on Visit Cigna Vision. Then select “Find a Cigna Vision Network Eye Care Professional” to search the Cigna Vision Directory. 2. Don’t have access to myCigna.com? Go to Cigna.com, top of the page select “Find A Doctor, Dentist or Facility”, click Cigna Vision Directory, under Additional Directories. 3. Prefer the phone? Call the toll-free number found on your Cigna insurance card and talk with a Cigna Vision customer service representative.

1/1/2020 Tennessee

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