Vision Insurance ______ offers vision coverage through Cigna. The Cigna vision plan allows you the flexibility to see any provider. You receive the highest level of benefit when you receive services from a participating provider. To find participating in-network providers, go to www. cigna.com and click on “Find a Doctor.” Below is a list of the reimbursement schedule.
VISION PPO PLAN In-Network
Out-of Network
Routine Eye Exams
$10 Copayment
Reimbursed up to $25
Reimbursed from $40 to $100 depending on type of lenses
Lenses
$25 Copayment
Frames
$130 allowance after $25 copayment
Reimbursed up to $71
One pair or single purchase per frequency Up to $110 (Allowance applied toward cost of supplemental contact lens professional services (including the fitting and evaluation) and lens materials. Non-selection contacts: up to a $105 allowance
Contact Lenses
Reimbursed up to $98
Frequency Exam
Once every 12 months Once every 12 months Once every 24 months
Lenses or contact lenses
Frames
EMPLOYEE PAYS PER PAY PERIOD
Employee Only
$--.-- $--.-- $--.-- $--.--
Employee + Spouse Employee + Child(ren)
Family
HEALTHESYSTEMS BENEFITS AT A GLANCE BEN FITS AT A GLANCE
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