Page 15 - Community Health Systems Guide 2018-FINAL

Benefits

Anthem Blue Cross | PPO Vision Plan

The Anthem Blue Cross vision plan provides professional vision care and high quality lenses and frames through a broad
network of optical specialists. You will receive richer benefits if you utilize a network provider. If you utilize a non‐network
provider, you will be responsible to pay all charges at the time of your appointment and will be required to file an itemized
claim with Blue View Vision.

Anthem Blue Cross
Blue View Vision PPO Plan

Network Non-Network
Vision Benefits
Copay
- Examination $10 Copay N/A
- Materials $10 Copay N/A
Examination (Every 12 Months) $10 Copay Up to $49 allowance
Lenses (Every 12 Months)
 Single Vision $20 Copay $35 Reimbursement
 Bifocal $20 Copay $49 Reimbursement
 Trifocal $20 Copay $74 Reimbursement

Frames (Every 24 Months) $130 Allowance Up to $50 allowance
Contact Lenses (Every 12 Months) In Lieu of Frames and Lenses
 Cosmetic / Elective $130 Allowance $92 Reimbursement
 Medically Necessary 100% $250 Reimbursement

Finding In-Network Vision Providers
Go to www.anthem.com/ca.com or call (866) 723-0515 and refer to the Blue View Vision, Plan BV5B network
when prompted.

Cigna | Basic Life and AD&D Insurance
Life insurance protects your family or other beneficiaries in the event of your death while you are still actively employed with the
company. Community Health System, Inc. pays for coverage, offered through Cigna, in the amount of:
- Exempt: $50,000
- Non Exempt: $10,000
If your death is due to a covered accident or injury, your beneficiary will receive an additional amount through Accidental
Death and Dismemberment (AD&D) coverage.

Selecting a Beneficiary
A beneficiary is the person or entity who you designate to receive your death benefits. Choosing a beneficiary and keeping
your beneficiary up-to-date is an essential part of owning life insurance. Please remember to review your beneficiary
designation as new situations arise, such as the birth or adoption of a child, marriage or divorce.

Cigna | Long Term Disability Insurance
Community Health Systems, Inc. offers you Long Term Disability (LTD) to provide income replacement if you become disa-
bled for an extended period of time, through Cigna. If you become totally and permanently disabled, benefits begin 90 days
after the start of your illness or injury. LTD works with state disability programs, Social Security, and any other group disabil-
ity coverage, to provide you with a combined monthly benefit equal to 60% of your pre‐disability earnings up to a maximum
benefit of $6,000 per month.

15