Vision Coverage
Regular eye examinations can not only determine your need for corrective eyewear, but also may detect general health problems in their earliest stages. Protection for the eyes should be a major concern to everyone, therefore regular eye exams are recommended. All benefits eligible employees may elect to enroll in the voluntary vision plan offered by Cigna.
Frequency of Benefits
| Service | In-Network Frequency | Out-of-Network Frequency |
|---|---|---|
| Eye Examination | One visit every calendar year | One visit every calendar year |
| Lenses | One pair every calendar year | One pair every calendar year |
| Frames | One pair every calendar year | One pair every calendar year |
| Contact Lenses (in lieu of glasses) | One visit every calendar year | One visit every calendar year |
Eye Examination
- In-Network Frequency
- One visit every calendar year
- Out-of-Network Frequency
- One visit every calendar year
Lenses
- In-Network Frequency
- One pair every calendar year
- Out-of-Network Frequency
- One pair every calendar year
Frames
- In-Network Frequency
- One pair every calendar year
- Out-of-Network Frequency
- One pair every calendar year
Contact Lenses (in lieu of glasses)
- In-Network Frequency
- One visit every calendar year
- Out-of-Network Frequency
- One visit every calendar year
Coverage Details
| Services | In-Network Provider | Out-of-Network Provider |
|---|---|---|
| EYE EXAMINATION | $20 copay | Up to $40 |
| Single Vision | $20 copay | Up to $32 |
| Bifocal | $20 copay | Up to $55 |
| Trifocal | $20 copay | Up to $65 |
| FRAMES* | $200 allowance + 20% off any remaining balance | Up to $80 |
| Elective - Conventional | $0 copay; 15% off balance over $200 allowance | Up to $104 |
| Elective - Disposable | $0 copay; $200 allowance | Up to $104 |
| Medically Necessary | $0 copay; covered in full with prior approval | Up to $200 |
| Fit and Follow-up Standard | Up to $40 | Not Covered |
| Fit and Follow-up Premium | 10% off retail price | Not Covered |
EYE EXAMINATION
- In-Network Provider
- $20 copay
- Out-of-Network Provider
- Up to $40
Single Vision
- In-Network Provider
- $20 copay
- Out-of-Network Provider
- Up to $32
Bifocal
- In-Network Provider
- $20 copay
- Out-of-Network Provider
- Up to $55
Trifocal
- In-Network Provider
- $20 copay
- Out-of-Network Provider
- Up to $65
FRAMES*
- In-Network Provider
- $200 allowance + 20% off any remaining balance
- Out-of-Network Provider
- Up to $80
Elective - Conventional
- In-Network Provider
- $0 copay; 15% off balance over $200 allowance
- Out-of-Network Provider
- Up to $104
Elective - Disposable
- In-Network Provider
- $0 copay; $200 allowance
- Out-of-Network Provider
- Up to $104
Medically Necessary
- In-Network Provider
- $0 copay; covered in full with prior approval
- Out-of-Network Provider
- Up to $200
Fit and Follow-up Standard
- In-Network Provider
- Up to $40
- Out-of-Network Provider
- Not Covered
Fit and Follow-up Premium
- In-Network Provider
- 10% off retail price
- Out-of-Network Provider
- Not Covered
Plan Notes
- Frame frequency increasing from 24 months to 12 months
- Allowance increasing from $130 to $200