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Benefits





         Vision Insurance


         PPO Vision Plan | EyeMed
         The EyeMed vision plan provides professional vision care and high quality lenses and frames through a broad network of optical
         specialists. You  will receive richer benefits if you utilize a network provider. If you utilize a non‐network provider, you will be
         responsible to pay all charges at the time of your appointment and will be required to file an itemized claim with EyeMed.


                                                               EyeMed                              Note
         Plan Name                                             PPO Plan                            The EyeMed

         Network Name                              Network                 Non-Network             network includes
                                                                                                   access to
         Vision Benefits                                                                           independent
                                                                                                   ophthalmologists
         Copay
          - Examination                           $10 Copay                    N/A                 and optometrists, as
          - Materials                             $10 Copay                    N/A                 well as
                                                                                                   LensCrafters®,
         Examination                                100%                $42 Reimbursement          Target Optical, Sears
         Lenses                                                                                    Optical, JCPenney
          - Single Vision                           100%                $35 Reimbursement          Optical and most
          - Bifocal                                 100%                $49 Reimbursement          Pearle Vision retail
          - Trifocal                                100%                $74 Reimbursement          stores.


         Frames                                  $130 Benefit           $65 Reimbursement
         Contact Lenses                                 In Lieu of Frames and Lenses
          - Cosmetic / Elective                  $105 Benefit           $84 Reimbursement
          - Medically Necessary                     100%                $210 Reimbursement
         Laser Vision Correction                Discounts Apply            Not Covered
         Frequency
          - Examination                                        12 Months
          - Lenses                                             12 Months
          - Frames                                             24 Months
          - Contact Lenses                                     12 Months




                        Finding a Vision Provider
                        Go to www.eyemedvisioncare.com or call (866) 723-0513. Refer to the “Access” network when prompted.























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