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Type of Service In Network Out of Network FrequencyCopay of Eye Exam $10 Copay Up to $45 Allowance once per 12 monthStandard Eyeglass LensesSingle VisionLined BifocalLined TrifocalLenticular$15 Copay$0 Copay$0 Copay$0 Copay$0 CopayNot coveredUp to $32 AllowanceUp to $55 AllowanceUp to $65 AllowanceUp to $80 Allowanceone pair per 12 monthFrame Allowance 100% up to $150 Retail Allowance Up to $110 Allowance one per 12 monthContact Lens Retail AllowanceElectiveTherapeutic100% up to $200 Retail Allowancecovered at 100%Up to $160 AllowanceUp to $210 Allowanceone per 12 monthVision PlanSee full plan summary for a more detailed plan explanation along with a list of exclusions and limitations.Finding an eye doctor:If you have access to mycigna.com and want to explore yourvision benefits, please follow the steps below.Login to mycigna.com, and at the top of the page select%u201cCoverage%u201d.The select %u201cVision%u201dUse the link to access the EyeMed website.After first-time setup it is set to auto-login to the EyeMed sitegoing forward.There will be a separate digital ID card for Cigna vision thatemployees can access by logging into mycigna.com andselecting %u201cID Cards%u201d at the top right of the page.If you don%u2019t have access to mycigna.com and want to search foran in network provider please follow the following steps.Go to cigna.com, and at the top of the page select %u201cFind aDoctor%u201d.Under How are you Covered? Select Employer or School.Scroll down and select Additional ResourcesThen select the appropriate directoryYou will select Cigna Vision Directory (Serviced by EyeMed).Employee No costEmployee + Spouse No costEmployee + Child(ren) No costFamily No costCigna Vision Serviced by EyeMedGetting reimbursed for a claim:Fill out the Cigna Vision claimform. You can find it online onCigna.com, or onmyCigna.com, under %u201cForms.%u201dMake sure to download theCigna Vision claim form andnot the medical form.1.2. Attach your itemized receipt.3. Send to: Cigna VisionClaim DepartmentP.O. Box 385018Birmingham, AL 35238-5018If you have any questions, callCigna customer service at the tollfree number found on your CignaVision ID card.18Vision Insurance Employee Cost Per Pay PeriodThe Cigna Vision plan through EyeMed, covering annual eye exams with a lowcopay and an allowance for glasses or contacts.