Exhibit 30b - Cal Yr 2025 City of Miami CIGNA Vision Benefit Summary imbedded in Medical ASO (VIS).pdf

01/01/2025 Florida

Welcome to Cigna Vision Schedule of Vision Coverage Effective Date: January 1, 2025

Vision Services and Frequency In-Network Benefit Reimbursement

Exam and Professional Services:

Frequency* : once per 12 month

Eye Exam $10 Copay

Eyeglass Lenses Allowances:

Frequency* : one pair per 12 month

Single Vision Lined Bifocal Lined Trifocal Progressives

Lenticular

Up to $20 Allowance Up to $30 Allowance Up to $40 Allowance Up to $30 Allowance Up to $75 Allowance

Contact Lenses Allowance:

Frequency* : one pair or single purchase per 12 month

Elective Therapeutic

Up to $75 Allowance Up to $75 Allowance

Frame Retail Allowance Frequency* : one per 12 month Up to $30 Allowance

* Your Frequency Period begins on January 1 (Calendar year basis)

Definitions:

Copay: the amount you pay towards your exam and/or materials, lenses and/or frames Coinsurance: the percentage of charges Cigna will pay. Customer is financially responsible for the balance.

Allowance: the maximum amount Cigna will pay. Customer is financially responsible for any amount over the allowance.

Pediatric Coverage: Benefits for employees/dependents under age 19, will have all in-network covered expenses paid at 100%, after copay; includes one prescription frame and one pair of single vision, lined bifocal or lined trifocal lenses including polycarbonate, tints, scratch and ultra-violet coating or contact lenses (one pair of conventional/12-month supply of disposable) including professional services, in lieu of frame and lenses, per frequency period.

Cigna Vision serviced by EyeMed City of Miami C4 Custom PPO Comprehensive Plan

Summary of Benefits Cigna Health and Life Insurance Company EXHIBIT 30b

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What’s Not Covered:

Orthoptic or vision training and any associated supplemental testing Medical or surgical treatment of the eyes Any eye examination, or any corrective eyewear, 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 usual 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 the policy Experimental or non-conventional treatment or device Magnification or low vision aids not shown as covered in the Schedule of Vision Coverage VDT (video display terminal)/computer eyeglass benefit

In-Network Coverage Includes*:

One vision and eye health evaluation including but not limited to eye health examination, dilation, refraction, and prescription for glasses;

Allowances can be applied, after your 30% In-Network savings, towards any covered prescription services/materials until material allowance exhausted, within the stated frequency

City of Miami C4 Custom PPO Comprehensive Plan

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Claims submitted and received in excess of twelve (12) months from the original Date of Service.

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How to use your Cigna Vision Benefits

Plan reimbursement

How to use your Cigna Vision Benefits Send a completed Cigna Vision service by EyeMed claim form and itemized receipt to: Cigna Vision, Claims Dept. c/oFAA PO Box 8504, Mason, OH 45040-7111

To get a Cigna Vision serviced by EyeMed claim form:

• Go to Cigna.com and go to Forms, Vision Forms, select the Cigna Vision serviced by EyeMed form

• Go to myCigna.com and go to your vision coverage page

Cigna Vision will pay for covered expenses within ten business days of receiving the completed claim form and itemized receipt.

Benefits are underwritten or administered by Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company. Read your plan carefully – this benefit summary provides a very brief description of the important features of your plans. This is not the insurance contract. Your full rights and benefits are expressed in the actual plan documents that are available to you upon request or a copy of the Vision Outline of Coverage is available and can be downloaded at Health Insurance & Medical Forms for Customers | Cigna under Vision Forms. Participating providers are independent contractors solely responsible for your routine vision examinations and products.

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Healthy Rewards® - is a discount program, not an insured benefit.

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How to use your Cigna Vision Benefits Plan reimbursement