Page 16 - 2019 Fontbonne

2019 Benefits Guide

VISION

Note—vision beneit Fontbonne continues to offer vision coverage through Cigna. Cigna

deductions are taken on a pre- utilizes the VSP network and also provides access to retail providers
such as LensCrafters, Pearle Vision, JCPenney, Target, etc. The vision
tax basis. plan covers routine eye exams and also pays for a portion of the cost of

Vision Contributions—Monthly 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
address. Lenses
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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