Vision Benefits

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	CIGNA VOLUNTARY VISION
	In-network	Out-of-network
Deductible	You pay	You pay
Eye Exam	$10 copay	Up to $45 allowance
Materials	$25 copay	Not applicable
Frequency
Exam	Once every 12 months	Once every 12 months
Lenses	Once every 12 months	Once every 12 months
Frames	Once every 12 months	Once every 12 months
Contact Lenses	Once every 12 months	Once every 12 months
Frames	Up to $130 allowance	Up to $71 allowance
Lenses
Single Vision Lenses	$25 copay	Up to $32 allowance
Bifocal Vision Lenses	$25 copay	Up to $55 allowance
Trifocal Vision Lenses	$25 copay	Up to $65 allowance
Lenticular Vision Lenses	$25 copay	Up to $80 allowance
Contact Lenses
Elective Contact Lenses	Up to $130 allowance	Up to $105 allowance
Medically Necessary Contact Lenses	Covered in full	Up to $210 allowance

	CIGNA VOLUNTARY VISION
Employee	$2.90
Employee + Spouse/Domestic Partner	$5.80
Employee + Child(ren)	$5.86
Employee + Family	$9.35

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