Page 10 - 2018 Metropolitan Development Enrollment
P. 10
Vision Coverage—Cigna
Because symptoms of health conditions often don’t appear until damage
has already occurred, eye exams are a great way to keep tabs on what’s
happening in your body. Your eyes are the only place in your body which
provide a clear view of your blood vessels, arteries, and a cranial nerve
which can tell your doctor a lot about your overall health. Our vision
insurance coverage, offered in partnership with Cigna, is designed to meet
a variety of needs.
Find an In-Network Provider
Remember to visit in-network providers to receive the deepest level of
discount on your services. To ind a participating in-network provider in
your area go to www.myCigna.com.
In-Network Out-of-Network
Copay
Exam $10 copay Up to $45
Materials $25 copay N/A
Lenses
Single Covered 100% after copay Up to $32
Bifocal Covered 100% after copay Up to $55
Trifocal Covered 100% after copay Up to $65
Lenticular Covered 100% after copay Up to $80
Frames
Frame Retail Allowance Up to $130, 20% off Up to $71
remaining balance
Contacts
Elective Up to $130 Up to $105
Medically Necessary $0 with prior approval Up to $210
Frequency
Exam 1 per calendar year
Lenses 1 per calendar year
Contacts (in lieu of glasses) 1 per calendar year
Frames 1 every other calendar year
This is a high level summary of your beneit coverage. Full coverage details are available in your
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
Semi-Monthly Pre-Tax Contributions
Employee $0.45
Employee + 1 $1.08
Employee + 2 or More $1.76
10 2018 Benefits Enrollment
Because symptoms of health conditions often don’t appear until damage
has already occurred, eye exams are a great way to keep tabs on what’s
happening in your body. Your eyes are the only place in your body which
provide a clear view of your blood vessels, arteries, and a cranial nerve
which can tell your doctor a lot about your overall health. Our vision
insurance coverage, offered in partnership with Cigna, is designed to meet
a variety of needs.
Find an In-Network Provider
Remember to visit in-network providers to receive the deepest level of
discount on your services. To ind a participating in-network provider in
your area go to www.myCigna.com.
In-Network Out-of-Network
Copay
Exam $10 copay Up to $45
Materials $25 copay N/A
Lenses
Single Covered 100% after copay Up to $32
Bifocal Covered 100% after copay Up to $55
Trifocal Covered 100% after copay Up to $65
Lenticular Covered 100% after copay Up to $80
Frames
Frame Retail Allowance Up to $130, 20% off Up to $71
remaining balance
Contacts
Elective Up to $130 Up to $105
Medically Necessary $0 with prior approval Up to $210
Frequency
Exam 1 per calendar year
Lenses 1 per calendar year
Contacts (in lieu of glasses) 1 per calendar year
Frames 1 every other calendar year
This is a high level summary of your beneit coverage. Full coverage details are available in your
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
Semi-Monthly Pre-Tax Contributions
Employee $0.45
Employee + 1 $1.08
Employee + 2 or More $1.76
10 2018 Benefits Enrollment
