Page 11 - 2019 Benefit Guide Non-CA

VISION COVERAGE

The AAG vision plan is offered through CIGNA, which has an extensive network of optometrists and vision care
specialists, as well as some retail locations.
You have the option to visit an in-network provider or an out-of-network provider. However, when you visit a
network provider you will receive a higher level of benefit and you are not required to complete claim forms. To
help you understand the features and coverage available to you, we’ve provided the following brief summary
of benefits. Please refer to plan documents for details, including important coverage exclusions and limitations.

Services In-Network Out-of-Network
Exam $10 copay Up to $45 allowance
(every 12 months)
Material Copay $25 copay Various allowance amounts apply
Single Lenses Covered in full Up to $32 allowance
(every 12 months)
Bifocal Lenses Covered in full Up to $55 allowance
(every 12 months)
Trifocal Lenses Covered in full Up to $65 allowance
(every 12 months)
Retail Frame Allowance Up to $130 Up to $71
(every 24 months)
Covered Selection Contacts Up to $120 Up to $100
(every 12 months)
Medically Necessary Contacts 100% Up to $210
(every 12 months)

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