VISION Protect your sight and enjoy those sunsets even more with vision insurance. Receive both preventive and materials coverage. DELUXE PLUS $0 COPAY EXAMS Covered at 100% LENSES Single: Covered at 100% Bifocal: Covered at 100% Trifocal: Covered at 100% Standard Progressive (Tier 1): Covered at 100% FRAMES $100 reimbursement CONTACT LENSES Disposable: $100 reimbursement Medically Necessary: Covered at 100% FREQUENCY OF SERVICES Exams: Adult-Once every 2 benefit periods; Children Through Age 18-Once every benefit period Lenses: Adult-Once every 2 benefit periods; Children Through Age 18-Once every benefit period Frames: Adult and Children Through Age 18-Once every 2 benefit periods Contact Lenses: Adult-Once every 2 benefit periods; Children Through Age 18-Once every benefit period RATES PER BIWEEKLY PAY PERIOD Employee: $1.00 Employee + Family: $3.00 The benefits and rates in this guide are for illustrative purposes only. To the extent the rates or the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases. REVIEW PLAN SUMMARY