STATEOFILLINOISYour company has selected EyeMed as your vision wellness program. This plan allows...

Your company has selectedEyeMed as your vision wellnessprogram. This plan allows youto improve your healththrough a routine eye exam,while saving you money onyour eye care purchases. Theplan is available throughthousands of providerlocations participating on theEyeMed ACCESS network.

To see a list of participatingproviders near you, go towww.eyemedvisioncare.com/STIL.You can also call1-866-723-0512.

Enroll today for an affordableway to help ensure a lifetimeof healthy vision.

For questions regardingbenefits, please call1-866-723-0512.

Value Added Features:In addition to the benefits above, the vision program also includes savings on the following:• Additional Eyewear - Save up to 40% off additional complete pairs of glasses after the initial benefit has been used. Thismoney-saving program is available at any participating provider.

• Eye Care Supplies - Receive 20% off retail price for eye care supplies like cleaning cloths and solutions purchased at network providers (notvalid on doctor's services or contact lenses).

• * Laser Vision Correction - Save 15% off regular price or 5% off promotional price for LASIK, PRK or e-LASIK procedures at U.S. Laser Visionnetwork surgeons. This discount may not always be available from a provider in your immediate location, so members should call1-866-723-0512 for the nearest facility. No claim forms are needed, making it a hassle free process for members.

• Replacement Contact Lens Purchases - Visit www.eyemedcontacts.com to order replacement contact lenses for shipment to your home atless than retail price. Your core benefit allowance will not apply to the service. Your initial pair of contact lenses must still be purchased fromyour eye care provider to ensure proper fit and follow-up care.

STATE OF ILLINOISIn-Network Out-of-Network

Vision Care Services Member Cost Reimbursement

Exam with Dilation as Necessary: $10 Copayment Up to $30 Allowance

Frames: $10 Copayment; Up to $175 retail frame cost; Up to $70 Allowancemember responsible for balance over $175

Standard Plastic Lenses:Single Vision $10 Copayment Up to $50 AllowanceBifocal $10 Copayment Up to $80 AllowanceTrifocal $10 Copayment Up to $80 AllowanceLenticular $10 Copayment Up to $80 AllowanceStandard Progressive $75 Up to $80 AllowancePremium Progressive $75, 80% of Charge less $120 Allowance Up to $80 Allowance

Lens Options (paid by the member and added to the base price of the lens):Tint (Solid and Gradient) $15 N/AUV Coating $15 N/AStandard Scratch-Resistance $15 N/AStandard Polycarbonate $40 N/AStandard Anti-Reflective $45 N/AOther Add-Ons and Services 20% off retail price N/A

Contact Lenses (allowance covers materials only):Conventional $0 Copayment; $120 Allowance;

member responsible for balance over $120 Up to $120 AllowanceDisposables $0 Copayment; $120 Allowance;

member responsible for balance over $120 Up to $120 Allowance

Low Vision (subject to prior approval by insurance carrier):Supplementary Testing $10 Copayment Up to $125 AllowanceVision Aides 100% Coverage after 25% Copayment 100% Coverage after 25%

with a $1,000 maximum allowance Copayment with a $1,000maximum allowance

Frequency:Exam Once every 12 monthsFrames Once every 24 monthsLenses or Contact Lenses Once every 24 monthsLow Vision Supplementary Testing Once every 12 monthsLow Vision Aides Once every 24 months

LASIK and PRK Vision Correction Procedures*: 15% off retail price OR N/A5% off promotional pricing

Additional Purchases and Out-of-Pocket Discount:

Member will receive a 20% discount on remaining balance at Participating Providers beyond plan coverage; which may not be combined with anyother discounts or promotional offers, and the discount does not apply to EyeMed’s Providers’ professional services or disposable contact lenses.Benefits are not provided for services or materials arising from except as provided in the Low Vision rider: orthoptic or vision training, subnormalvision aids and any associated supplemental testing; aniseikonic lenses; medical and/or surgical treatment of the eyes; corrective eyewear requiredby an employer as a condition of employment, and safety eyewear unless specifically covered under the plan; services provided as a results ofWorkers’ Compensation law; plano (non-prescription) lenses and non-prescription sunglasses (except for the 20% EyeMed discount); two pairs ofglasses in lieu of bifocals; services or materials provided by any other group benefit providing vision care. Lost or broken lenses, frames, glasses, orcontact lenses will not be replaced except in the next benefit period. Coverage will end on the earliest of: the date the policy ends; end of graceperiod in which premium has not been paid; the date the employee’s employment ends; or the date the employee is no longer eligible.Underwritten by Fidelity Security Life Insurance Company of Kansas City, Missouri. The Certificate of Insurance is available atwww.benefitschoice.il.gov. Policy No. VC-19, M-9083.