Page 17 - Fontbonne New Hire

Fontbonne University

Vision Note—vision beneit

Fontbonne offers vision coverage through Cigna. Cigna utilizes the VSP deductions are taken on a pre-
network and provides access to retail providers such as LensCrafters, tax basis.
Pearle Vision, JCPenney, Target, etc. The vision plan covers routine eye Vision Contributions—Monthly
exams and also pays for a portion of the cost of glasses or contact lenses. Employee only $7.55
Employee + spouse $15.09
To ind an in-network vision provider, please visit www.cigna.com, Employee + child(ren) $15.24
click on the orange “Find a Doctor” tab at the top, then select “Vision Family $24.33
Directory—Routine Eye Exam & Eyewear” from the directory list.

Cigna/VSP
In-Network Out-of-Network Each employee with receive two
Vision Exam personalized ID cards for vision
$10 copay Reimbursed up to $45 coverage, mailed to your home
Lenses address.
Single $15 copay Reimbursed up to $32
Bifocal $15 copay Reimbursed up to $55
Trifocal $15 copay Reimbursed up to $65
Lenticular $15 copay Reimbursed up to $80
Frames
$200 allowance; 20% Reimbursed up to $110
discount on amount over
$200
Contacts
Elective $200 allowance Reimbursed up to $160
Medically required Covered in full $210 allowance
Frequency
Exam Once every 12 months
Lenses Once every 12 months
Contacts Once every 12 months
Frame Once every 24 months

Note: contacts must be in lieu of lenses and frames. Beneit frequencies reset on a calendar year
basis.

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