Page 15 - 2018 Fontbonne Benefit Guide

Fontbonne University

Vision

Fontbonne continues to offer vision coverage through Cigna. Cigna Note—vision beneit

utilizes the VSP network and also provides access to retail providers deductions are taken on a pre-
such as LensCrafters, Pearle Vision, JCPenney, Target, etc. The vision
plan covers routine eye exams and also pays for a portion of the cost of tax basis.
glasses or contact lenses. Vision Contributions—Monthly
Employee only $7.55
To ind an in-network vision provider, please visit www.cigna.com, Employee + spouse $15.09
click on the orange “Find a Doctor” tab at the top, then select “Vision Employee + child(ren) $15.24
Directory—Routine Eye Exam & Eyewear” from the directory list. Family $24.33

Cigna/VSP
In-Network Out-of-Network Each employee with receive two
Vision Exam personalized ID cards for vision
coverage, mailed to your home
$10 copay Reimbursed up to $45 address.
Lenses
Single $15 copay Reimbursed up to $32
Bifocal $15 copay Reimbursed up to $55
Trifocal $15 copay Reimbursed up to $65
Lenticular $15 copay Reimbursed up to $80
Frames
$200 allowance; 20% Reimbursed up to $110
discount on amount over
$200
Contacts
Elective $200 allowance Reimbursed up to $160
Medically required Covered in full $210 allowance
Frequency
Exam Once every 12 months
Lenses Once every 12 months
Contacts Once every 12 months
Frame Once every 24 months

Note: contacts must be in lieu of lenses and frames. Beneit frequencies reset on a calendar year
basis.

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