Page 9 - 15OE

Electric Power Systems

Personalized ID cards for vision coverage
will be mailed to your home address.
Voluntary Vision

Vision coverage is transitioning from Guardian to Cigna, and utilizes

the VSP network, while also having access to retail providers such as
LensCrafters, Pearle Vision, JCPenney, Target, etc. The vision plan
covers routine eye exams and also pays for all or a portion of the cost
of glasses or contact lenses if you need them.

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.

9