UPMC Health Benefits, Inc. 2025_SOB_Vision_Care_LG 4O Page 3 of 8 Additional Discounted Services Included NVA EYEESSENTIAL® Plan* The NVA EYEESSENTIAL® Plan is an additional benefit available to all members once the benefits as described in this Schedule of Benefits have been exhausted for the term. Benefit frequencies are unlimited, excluding examination. For more information, see the Plan document in your enrollment materials or on the UPMC Health Plan member site. To see if your vision provider is participating visit www.upmchealthplan.com and select Find Care Mail-Order Contact Lens Replacement Program For more information on this program, call Contact Fill® at 1-866- 234-1393, or visit www.contactfill.com Lasik Surgery Participants are also eligible for discounts on LASIK surgery, when received at one of the following preferred providers: UPMC Eye Center, TLC Vision, Qualsight, or LCA. *Not all Participating Vision Providers participate in the NVA Essential network IMPORTANT: IF MEMBERS CHOOSE EXTRA OPTIONS, THEY ARE RESPONSIBLE FOR THE ADDITIONAL COST OF THE OPTIONS PAID DIRECTLY TO THE PROVIDER. This Vision Schedule of Benefits may expand or restrict the benefits set forth in your Vision Certificate of Insurance. See the Vision Certificate of Insurance for the details of the terms of coverage for your health benefit plan. In the event that the terms of your Vision Certificate of Insurance conflict with this Vision Schedule of Benefits the terms of this Vision Schedule of Benefits control. Pediatric Vision Services (if applicable) are covered as required under the Affordable Care Act (ACA) for Members enrolled in ACA-compliant group plans. Find eligibility and benefit details in your Pediatric Vision Certificate of Insurance and Pediatric Vision Schedule of Benefits on the UPMC Health Plan member site or call Member Services.*