Page 11 - AAG Benefits Guide OOS (Non-CA) Employees

2021 10
BENEFITS

VISION COVERAGE BENEFITS YOUR COPAY NETWORK
OUT-OF-
AMOUNT
The AAG vision plan is offered through Exam $10 copay Up to $45
CIGNA, which has an extensive network (every 12 months) allowance
of optometrists and vision care specialists, Material Copay $25 copay Various allowance
amounts apply
as well as some retail locations.
Single Lenses Covered in full Up to $32
You have the option to visit an in- (every 12 months) allowance
network provider or an out-of-network Bifocal Lenses Covered in full Up to $55
provider. However, when you visit a (every 12 months) allowance
Up to $65
network provider you will receive a Trifocal Lenses Covered in full allowance
(every 12 months)
higher level of benefit and you are not Retail Frame
required to complete claim forms. To Allowance Up to $130 Up to $71
help you understand the features and (every 24 months)
coverage available to you, we’ve Covered Selection
provided the following brief summary of Contacts Up to $120 Up to $100
(every 12 months)
benefits. Please refer to plan documents Medically
for details, including important coverage Necessary Contacts 100% Up to $210
exclusions and limitations. (every 12 months)

WHAT ARE YOUR 2021 VISION PLAN RATES?

Employee Only cost is CIGNA VISION PLAN - PER PAY PERIOD COST
paid by AAG if you enroll EMPLOYEE EMPLOYEE & EMPLOYEE & EMPLOYEE &
in the Medical plan PLAN ONLY SPOUSE CHILDREN FAMILY
PPO $3.63 $7.25 $7.34 $11.69

DEPENDENT CARE FSA (ADMINISTERED THROUGH CIGNA)

A Dependent Care FSA lets you use pretax dollars to pay for eligible expenses related to the care
for your child, disabled spouse, elderly parent, or other dependent who is physically or mentally
incapable of self-care, so you can work, or if you’re married, for your spouse to work, look for work
or attend school full time.
Who Is Eligible? How It Works Eligible Expenses
To qualify for a dependent care FSA: // The maximum allowed by // Before school and after school

// You and your spouse the IRS is $5,000 a year // Expenses for preschool/nursery school
must work or attend for individuals or married // Extended school programs
school full-time couples filing jointly, or // Au pair services (amounts paid for
// Your child must be under $2,500 for a married the actual care of the dependents)
age 13 or a tax-eligible person filing separately // Baby sitter (in or out of the home)
dependent who can’t // Submit a claim for
care for him or herself your eligible dependent // Nanny services (amounts paid for
// You don’t need to be care expenses the actual care of the dependents)
enrolled in a health // Get the money back // Summer day camp for your
plan to participate in from your dependent qualifying child under age 13
a dependent care FSA care account // Elder day care for a
qualifying individual