Page 12 - NH Guide

12

Vision

Cigna is our vision insurance provider, and you have access to VSP’s large
network of providers. To verify your provider is in-network, please visit

https://cigna.vsp.com. Franke’s vision plan covers the following.

In-Network Out-of-Network”
Exam $10 copay $45 allowance
Materials copay $25 copay N/A
Lenses
Single Covered in full $32 allowance
Bifocal Covered in full $55 allowance
Trifocal Covered in full $65 allowance
Lenticular Covered in full $80 allowance
Frames
$150 allowance $83 allowance
Contacts
Elective $130 allowance $105 allowance
Medically necessary Covered in full $210 allowance
Frequency
Exam 12 months 12 months
Lenses 12 months 12 months
Contacts (in lieu of glasses) 12 months 12 months
Frames 24 months 24 months
You are encouraged to seek services from a VSP network professional to

take advantage of the network discounts allowing you to take maximum
advantage of the eye exam and materials allowance. If you seek services
from non-network providers, you must pay for the service and ile a claim
with Cigna for reimbursement.

Vision Bi-Weekly Contributions—Paid By You on a Pre-Tax
Basis

Coverage Tier
Employee only $1.31
Employee + spouse $2.61
Employee + child or children $2.64
Family $4.22

Franke