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CIP Vision Plan
Vision coverage is provided at no additional cost to benefit recipients enrolled in any of the CIP health plans. All benefit recipients and enrolled dependent beneficiaries have the same vision coverage regardless of the health plan selected. All vision benefits are available once every 24 months from the last date used. Copayments are required.
The plan administrator for the vision benefit is EyeMed. Requests for reimbursement for services provided by an out-of-network vision provider must be submitted on an EyeMed claim form [PDF, 134KB].
| Service | In Network | Out-of-Network** | Frequency |
|---|---|---|---|
| Eye Exam | $10 copayment | $20 allowance | Once every 24 months |
|
Standard Frames
|
$10 copayment
(up to $90 retail frame cost; member responsible for balance over $90)
|
$20 allowance
|
Once every 24 months |
|
Vision Lenses*
(single, bifocal and trifocal) |
$10 copayment
|
$20 allowance for single vision lenses
$30 allowance for bifocal and trifocal lenses
|
Once every 24 months |
| Contact Lenses (all contact lenses are in lieu of spectacle lenses) |
$20 copayment for medically necessary $50 copayment for elective contact lenses $70 allowance for all other lenses not mentioned above |
$70 allowance | Once every 24 months |
* Vision Lenses: Plan participant pays any and all optional lens enhancement charges. In-Network providers may offer additional discounts on lens enhancements and multiple pair purchases.
** Out-of-network claims must be filed within one year from the date of service.