Page 13 - Guide

Vision

Fontbonne offers vision coverage through Cigna. Cigna utilizes the VSP Note—vision beneit

network and provides access to retail providers such as LensCrafters, deductions are taken on a pre-
Pearle Vision, JCPenney, Target, etc. The vision plan covers routine eye
exams and also pays for a portion of the cost of glasses or contact lenses. tax basis.
Vision Contributions—Monthly
To ind an in-network vision provider, please visit www.cigna.com, Employee only $7.55
click on the orange “Find a Doctor” tab at the top, then select “Vision Employee + spouse $15.09
Directory—Routine Eye Exam & Eyewear” from the directory list. Employee + child(ren) $15.24
Family $24.33
Cigna/VSP
In-Network Out-of-Network
Vision Exam
$10 copay Reimbursed up to $45
Lenses
Single $15 copay Reimbursed up to $32 Each employee with receive two
Bifocal $15 copay Reimbursed up to $55 personalized ID cards for vision
Trifocal $15 copay Reimbursed up to $65 coverage, mailed to your home
Lenticular $15 copay Reimbursed up to $80 address.
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.

13