Page 10 - Rampart EE Guide 01-20.pub
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BENEFITS





         VISION INSURANCE


         Cigna | PPO Vision Plan
         The Cigna vision plan provides professional vision care and high quality lenses and frames through a broad network of op cal
         specialists.  You  will  receive  richer  benefits  if  you  u lize a  network provider.  If  you  u lize  a  non‐network  provider,  you  will  be
         responsible to pay all charges at the  me of your appointment and will be required to file an itemized claim with Cigna.


                                                                 Cigna                             Note
         Plan Name                                                PPO                              Cigna has the largest

         Network Name                             Cigna Vision             Non‐Network             network of private‐
                                                                                                   prac ce eye care
         Vision Benefits                                                                           doctors in the
                                                                                                   industry. Cigna’s
         Copay
          ‐ Examina on                            $10 Copay                    N/A                 network includes
          ‐ Materials                             $20 Copay                    N/A                 37,000 access points
                                                                                                   na onwide. Most of
         Examina on (Every 12 Months)                100%               $45 Reimbursement          the U.S. popula on
         Lenses (Every 12 Months)                                                                  lives within four
          ‐ Single Vision                            100%               $32 Reimbursement          miles of a Cigna
          ‐ Bifocal                                  100%               $55 Reimbursement          provider.
          ‐ Trifocal                                 100%               $65 Reimbursement
          ‐ Len cular                                100%               $80 Reimbursement
         Frames (Every 24 Months)               $150 Allowance          $83 Reimbursement
         Contact Lenses (Every 12 Months)               In Lieu of Frames and Lenses

          ‐ Cosme c / Elec ve                   $150 Allowance          $120 Reimbursement
          ‐ Medically Necessary                      100%               $210 Reimbursement
         Laser Vision Correc on                 Discounts Apply             Not Covered



                        Finding a Vision Provider
                        Go to MyCigna.com or if not enrolled, www.cigna.com and click on “Find a Doctor”.   Under “Addi onal
                        Directories” click on “Cigna Vision Directory” or call (800) 244‐6224.




         Tips for Using Your Vision Benefits

             Understand your benefits.
         
             Our Vision insurance plan covers preven ve care services such as eye exams and vision tests, eyeglass lenses, eyeglass frames
             and  contact lenses. It also provides discounts on elec ve procedures like LASIK and other vision correc on surgery. For some
             services, you’ll be provided an allowance. For instance, frames are covered in‐network with a $150 allowance, and if the
             frames you want cost more than that, you’ll have to pay the addi onal cost yourself.

             Get your eyes checked each year.
         
             Because eye exams can detect hidden medical problems, even those with perfect vision shouldn’t skip them. As you age,
             you’ll need more frequent vision exams.






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