CIGNA’s Open Access In-Network Plan (OAPIN) includes a vision plan benefit. The benefits differ from the optional VSP Vision Plan. It is possible that an employee on the OAPIN plan could have both vision plans, if the optional VSP coverage was selected during benefit re-enrollment in November.
Eye doctor visits for non-routine eye exams, will be covered under the medical portion of your plan, if the eye doctor is a CIGNA medical provider. This would include visits related to a diagnosed eye condition, including chronic conditions, eye injuries, infections, etc.
Note: Colby OAPIN members (who did not select the optional VSP Vision Plan during benefit re-enrollment) must see a CIGNA Vision provider for their routine eye exams under the Vision Plan.
Before you have your routine eye exam, be sure your eye doctor is part of CIGNA’s VISION PLAN NETWORK. Some doctors are part of the CIGNA network for medical claims, but are not part of the VISION PLAN network. If your eye doctor is not part of the CIGNA VISION PLAN, you will be charged for the exam and can submit a claim form (with receipts) for a $45 reimbursement. See below for instructions on locating eye doctors who participate in the CIGNA Vision Plan.
CIGNA Open Access In-Network Plan Vision Plan
If you are covered under the OAPIN plan, your vision plan covers:
- One vision and eye health evaluation every 24 months, including, but not limited to eye health exam, dilation, refraction, and prescription for glasses.
- The exam requires a $25 copay, and is covered in full, up to the reasonable and customary charge for service and materials. Please see important note about participating eye doctors above.
- The Vision Network Savings Program – receive a minimum of 20% savings on additional purchase of frames and/or lenses, including lens options, with a valid prescription. Offered savings does not apply to contact lens materials. Check with your CIGNA Vision Network eye care professional for details.
To use your CIGNA Vision Benefits:
- Locate a CIGNA Vision network eye care professional (see below for instructions on locating a provider).
- Schedule an appointment. Be sure to identify yourself as a CIGNA Vision Enrollee.
- At your appointment, present your CIGNA Vision ID Card, which will allow the doctor’s office to access your plan benefits and verify eligibility.
If you visit an out-of-network eye care professional, you are eligible for a $45 reimbursement:
- Pay for the exam in full.
- Submit a completed CIGNA Vision Claim form with itemized receipt to:
CIGNA Vision, Claims Department
PO Box 997561
Sacramento, CA 95899-7561
- Reimbursement of covered services will be paid to the subscriber, within 10 business days of receipt.
Find an In-Network Vision Provider for Routine Eye Exams
To locate a CIGNA Vision network eye care professional:
- Go to www.myCIGNA.com, and log in. (If you have not registered for a myCIGNA account, you can register on this web page.)
- Click on the My Plans tab.
- Scroll down to the Vision Benefits section in the middle of the page and click on the link to “View your CIGNA Vison benefit details”.
- Either click on the Find a Vision Provider tab or the link under the Welcome box at the top right of the page.
- On the form, enter the town, state and zip for the area you are searching.
- If you have additional questions, call CIGNA Vision Member Services at 1-877-478-7557.
CIGNA Vision Plan Exclusions
Standard coverage excludes:
- Orthoptic or vision training and any associated supplemental testing
- Medical or surgical treatment of the eyes ·
- Any eye examination, or any corrective eye wear, required by an employer as a condition of employment
- Any injury or illness when paid or payable by Workers’ Compensation or similar law, or which is work-related
- Charges in excess of the Reasonable and Customary charge for the Service or Materials
- Charges incurred after the policy ends or the insured’s coverage under the policy ends, except as stated in policy
- Experimental or non-conventional treatment or device
- Claims submitted and received in-excess of twelve (12) months from the original Date of Service