2025-2026 Employee Benefit Guide - Huntington UFSD (6.26.25)

[Benefit]

Medical Benefits

Vision Benefits

800.555.5555 www.myCIGNA.com

Employees that enroll into one of the Cigna Open Access Plus medical plans are also provided with a comprehensive vision plan through Cigna. To locate a Cigna Vision network eye care professional visit www.myCIGNA.com or call Cigna Vision Member Services at 877.555.5555.

OPEN ACCESS PLUS H.S.A.

BENEFIT

IN-NETWORK

OUT-OF-NETWORK

Health Savings Account Employer Funded (Funded on a weekly basis during your employment)

Annual Benefit Amount per Calendar Year Individual: $1,125 ($21.63 per week) Family: $2,250 ($43.27 per week)

CIGNA VISION PLAN

OUT-OF-NETWORK REIMBURSEMENT

FREQUENCY CALENDAR YEAR

BENEFIT

IN-NETWORK

Annual Deductible

Individual: $1,500 Family: $3,000

Individual: $3,000 Family: $6,000

Exam Copay

$15 copay

Up to $45

12 Months

Coinsurance

100%

70%

Materials Copay

$30 copay

N/A

24 months

Out-of-Pocket Maximum

Individual: $3,000 Family: $6,000

Individual: $4,500 Family: $9,000

Lenses: (one pair per frequency) Single Vision

Covered 100% after $30 copay Covered 100% after $30 copay Covered 100% after $30 copay Covered 100% after $30 copay

Up to $32 Up to $55 Up to $65 Up to $80

24 Months 24 Months 24 Months 24 Months

Bifocal Trifocal Lenticular

Lifetime Maximum

Unlimited

Unlimited

Outpatient Care Primary care physician office visits Specialist office visits Outpatient facility surgery

Covered at 100% after deductible Covered at 100% after deductible Covered at 100% after deductible

70% after deductible 70% after deductible 70% after deductible

Contact Lenses: (one pair or single purchase per frequency) Elective Allowance Therapeutic Allowance

Up to $100 Covered 100%

Up to $87 Up to $210

24 Months 24 Months

Preventive Care

Covered at 100%

70% after deductible

Hospital Care

Covered at 100% after deductible

70% after deductible

Frame Retail Allowance (once per frequency)

Up to $100

Up to $55

24 Months

Emergency Care At hospital emergency room Urgent Care Prescriptions* Retail Pharmacy (30 day supply) Generic Preferred Brand Non-Preferred Brand

Covered at 100% after deductible Covered at 100% after deductible

100% after deductible 100% after deductible

Copays apply after Medical deductible has been met.

Copays apply after Medical deductible has been met.

DISCOUNT VISION ACCESS PROGRAM* Employees enrolled in the Guardian Dental plan are eligible to receive discounts on vision care services or supplies through Vision Service Plan’s PPO network. When you are no longer enrolled in a Guardian dental plan, access to the network discounts ends.

$10 copay $20 copay $35 copay $20 copay $40 copay $70 copay

VSP: 877.814.8970 www.guardiananytime.com

70% after deductible

Mail Order (90 day supply) Generic Preferred Brand Non-Preferred Brand

Not covered

AVERAGE DISCOUNTS*

Eye Exams:

20% off the VSP doctor’s usual charge

If you and your doctor require the brand name drug instead of the generic, your doctor will need to indicate Dispense As Written (DAW) on your prescription to avoid paying the higher cost.

20% off VSP doctor’s usual charge, when complete pair of prescription glasses is purchased

Frames, Standard Lenses and Lens Options:

Please note that balance billing applies when utilizing Out-of-Network services.

Contact Lens Professional Services:

15% off VSP doctor’s usual charge for professional services. The contact lenses are not discounted An average of 15% off the laser surgeon's usual charge or 5% off of any promotional price, if it is less than the usual discounted price

For additional plan information, please refer to your detailed plan design provided by the carrier. In the event of a discrepancy, the carrier Plan Document shall prevail.

Laser Surgery:

REMINDER: Precertification is required for hospital admissions and select outpatient services based on your plan. If you use a health care professional in Cigna’s network, your doctor will work with Cigna to arrange for precertification. If you use a health care professional who does not participate with Cigna, you are responsible for obtaining precertification.

* This is not insurance. You must pay the entire discounted fee directly to the VSP network doctor. NO ID cards are required, but the patient must notify the VSP network doctor that they have the Guardian VSP Access Plan at the time of service to receive their discount. Discounts are only available from the VSP network doctor that provided the eye exam to the patient within the last 12 months.

For additional plan information, please refer to your detailed plan design. In the event of a discrepancy, the carrier Plan Document shall prevail.

For additional plan information, please refer to your detailed plan design. In the event of a discrepancy, the carrier Plan Document shall prevail.

QUESTIONS? Call BenefitsVIP at 866.000.0000

QUESTIONS? Call BenefitsVIP at 866.000.0000

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