Page 9 - Guide

Voluntary Vision 2017 Beneits Enrollment

Vision coverage is provided by Cigna, and utilizes the VSP network, while also
having access to retail providers. The vision plan covers routine eye exams and also Personalized ID cards
for vision coverage will be
pays for all or a portion of the cost of glasses or contact lenses if you need them. mailed to your home address.

To ind an in-network vision provider, please visit www.cigna.com, click on the
orange “Find a Doctor” tab at the top, then select “Vision Directory—Routine Eye
Exam & Eyewear” from the directory list.

Employee Bi-Weekly Payroll Contributions
Employee $2.16
Employee + spouse $4.33
Employee + child(ren) $4.38
Family $6.98

In-Network Out-of-Network
Reimbursement
Copay
Exam $20 Amount over: $45
Lenses
Single $20 Amount over: $32
Bifocal $20 Amount over: $55
Trifocal $20 Amount over: $65
Lenticular $20 Amount over: $80
Frames $120 allowance 20% Amount over: $66
discount on balance
Contacts $120 allowance Amount over: $100
Frequency
Exam 12 months
Lenses 12 months
Contacts (in lieu of glasses) 12 months
Frames 24 months

Note: beneit frequency is on a calendar year basis.

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