Page 11 - 2022 Iodine Software Benefit Guide

Vision plan

The vision plan provides coverage for routine eye exams and pays for all or a portion of the cost of glasses or contact
lenses. You can choose any provider; however, you always save money if you see in-network providers. We offer a vision
plan through Cigna.

Cigna Vision Plan
Plan Provisions In-Network Out-of-Network

Exam $10 copay Up to $45 reimbursement
$200 allowance plus
Frames 20% off balance over $200 Up to $110 reimbursement

Lenses
● Single vision lenses $10 copay Up to $40 reimbursement
● Bifocal lenses $10 copay Up to $65 reimbursement
● Trifocal lenses $10 copay Up to $75 reimbursement
Contact Lenses
● In lieu of glasses $200 allowance Up to $160 reimbursement
Frequency
● Exam 12 Months 12 Months
● Lenses 12 Months 12 Months
● Frames 12 Months 12 Months
● Contact lenses 12 Months 12 Months

Please review your plan document for an exact description of the services and supplies that are covered, those which are excluded or limited,
and other terms and conditions of coverage.

Vision Plan Provider Information
Cigna
Claims, Benefits: www.cigna.com
Network: Cigna Vision Network
Customer Service: 866-494-2111
Group No.: 0629062

11