Page 2 Benefit plan and features Necessary Contact Lenses (in lieu of prescription eyeglasses) Covered in Full $25 Up to $210 Every months 12 *Frequency is calculated from last date of service/last date of purchase. **Costco in-network frame allowance is . $70 For Laser Vision Surgery, you will receive an average of 15% off the regular price or 5% off the promotional price when you visit a VSP contracted laser center. These are discounted, not insured services, and are not available for out-of-network providers, at Costco and Walmart or other in-network providers that are not VSP contracted laser centers. Provider Network We partnered with a vision network, VSP®, so you can choose a credentialed provider at any of the 114,000 access points and over 22,000 retail chain locations. You can locate an in-network provider by visiting: www.equitable.com/findvision Understanding your benefits Commonly Used Terms Frequency: How often a member can use their exam and materials benefit. Benefits are calculated from date of service. Co-pays: What a member is expected to pay out-of-pocket at time of service to the provider In-network: Eye care providers that have agreed to provide eye care services at discounted rates for participants. Out-of-network: Eye care providers who have not agreed to provide eye care services at discounted rates for participants. Frequently Asked Questions Am I covered for severe visual problems not correctable with regular lenses? Yes, this is referred to as Low Vision benefits. You are covered for $1,000 individual maximum every 2 years in and out of network combined for all Low Vision services and materials. There is no deductible. There are two different benefits included – Supplemental Testing and Supplemental Aids. Refer to your certificate of insurance for full details. When can I enroll? You can enroll when you are initially eligible for benefits and during any subsequent annual enrollment period defined by your employer or if there is a life status change, such as involuntary termination under another policy. Are my dependents eligible for coverage? Your spouse or domestic partner, and your dependent children up to the end of the month they reach age 26 are eligible. How do I find an in-network provider? To find a provider near you, please visit www.equitable.com/findvision . Are there major retailers in-network? Yes, the VSP network includes retail chain locations like Walmart/Sam’s Club, Costco Optical® and Cohen’s Fashion Optical®, RX Optical, Wisconsin Vision, Eyeconic. Visionworks, while not a retailer, is also in-network. Can I see a provider outside of the network? Yes, you can see a provider outside of the network, but your out-of-pocket cost will likely be higher as out-of-network providers have not agreed to discounted rates on their materials or services. If I get frames, can I get contacts too? Frames are in lieu of contact lenses. You are not eligible to receive both in the same benefit period. How do I learn more about my benefits? Go to www.equitable.com/employeebenefits and log on to EB360® to view your account details.