Page 29 - Skechers 2022 Benefits Guide
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INTERNATIONAL – CIGNA DENTAL PLAN OVERVIEW
CIGNA INTERNATIONAL – DENTAL PLAN*
You automatically receive the International CIGNA dental plan when electing the International CIGNA medical plan.
INTERNATIONAL – CIGNA VISION PLAN OVERVIEW
CIGNA INTERNATIONAL – VISION PLAN*
You automatically receive the International CIGNA vision plan when electing the International CIGNA medical plan.
CIGNA INTERNATIONAL DENTAL PLAN
ANY LICENSED PROVIDER
CIGNA INTERNATIONAL DENTAL PLAN
ANY LICENSED PROVIDER
Your Cost Share Shown Below
Services
Calendar Year Deductible Maximum Calendar Year Benefit Diagnostic & Preventive
Basic Restorative
Major Services- Crowns, Dentures Orthodontic Services
$50 Individual / $100 Family $1,500
No Charge
20%
50%
Not Covered
Services
Eye Exam (every 12 month) Frames (every 12 months) Contact Lenses (every 12 months)
Basic Lenses (every 12 month)
Single Bifocal Trifocal Lenticular
$30 Copay
Allowance up to $125 Allowance up to $125
Allowance up to $40 Allowance up to $40 Allowance up to $60 Allowance up to $80
Your Cost Share Shown Below
*When in the US, use a Cigna dental provider to receive greater coverage. To find participating providers, please visit Cigna’s website at: cignaenvoy.com or call 800-441-2668.
CIGNA INTERNATIONAL
Member Services (U.S. Domestic Only): 800-441-2668 Member Services (International Collect Calls): +1-302-797-3100 Website: cignaenvoy.com
2022 BENEFITS 29
