Additional discounts

Take a sneak peek before enrolling

SUMMARY OF BENEFITS

BLM2015

Premium progressives and premium anti-reflective designations are subject to annual review by EyeMed’s Medical Director and are subject to change based on marketconditions. Fixed pricing is reflective of brands at the listed product level . All providers are not required to carry all brands at all levels.

_____________________________ _________________________________________ _________________

ICUBA Base Plan

Vision Care In-Network Out-of-NetworkServices Member Cost Reimbursement

ExamWith Dilation as Necessary $5 Co-pay Up to $35

Retinal Imaging Up to $39 N/A

Frames $0 Co-pay; $100 allowance; 20% off balance over $100 Up to $50

Standard Plastic LensesSingle Vision $15 Co-pay Up to $20Bifocal $15 Co-pay Up to $40Trifocal $15 Co-pay Up to $60Standard Progressive Lens $65 Co-pay Up to $45Premium Progressive Lens $85 Co-pay - $110 Co-payTier 1 $85 Co-pay Up to $45Tier 2 $95 Co-pay Up to $45Tier 3 $110 Co-pay Up to $45Tier 4 $65 Co-pay, 80% of charge less $120 Allowance Up to $45

Lenticular $15 Co-pay Up to $60

Lens Options (paid by the member and added to the base price of the lens)UV Treatment $15 N/ATint (Solid and Gradient) $15 N/AStandard Plastic Scratch Coating $15 N/AStandard Polycarbonate $40 N/AStandard Polycarbonate - Kids under 19 $0 Up to $20Standard Anti-Reflective Coating $45 N/APremium Anti-Reflective Coating $57 - $68 N/ATier 1 $57 N/ATier 2 $68 N/ATier 3 80% of charge N/A

Photochromic/Transitions $75 N/APolarized 20% off retail price N/AOther Add-Ons and Services 20% off retail price N/A

Contact Lens Fit and Follow-Up (Contact lens fit and two follow up visits are available once a comprehensive eye exam has been completed)

Standard Contact Lens Fit & Follow-Up Up to $40 N/APremium Contact Lens Fit & Follow-Up 10% off retail N/A

Contact LensesConventional $0 Co-pay; $100 allowance; 15% off balance over $100 Up to $80Disposable $0 Co-pay; $100 allowance; plus balance over $100 Up to $80Medically Necessary $0 Co-pay, Paid-in-Full Up to $210

Laser Vision CorrectionLasik or PRK from U.S. Laser Network 15% off the retail price or 5% off the promotional price N/A

Hearing CareHearing Health Care from 40% off hearing exams and a low price guarantee N/AAmplifon Hearing Network on discounted hearing aids

FrequencyExamination Once every 12 monthsLenses or Contact Lenses Once every 12 monthsFrame Once every 24 months

40%Complete pairof prescriptioneyeglasses

20%Non-prescriptionsunglasses

20%Remaining balancebeyond plan coverage

These discounts are forin-network providers only

OFF

OFF

OFF

• You’re on the INSIGHTNetwork

• For a complete list ofin-network providersnear you, useour Enhanced ProviderLocator onwww.eyemed.com orcall 1-866-804-0982.

• For Lasik providers, call1-877-5LASER6.

AH2015

Premium progressives and premium anti-reflective designations are subject to annual review by EyeMed’s Medical Director and are subject to change based on marketconditions. Fixed pricing is reflective of brands at the listed product level . All providers are not required to carry all brands at all levels. Benefits are not provided from services ormaterials arising from: 1) Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; 2) Medical and/or surgical treatment of the eye,eyes or supporting structures; 3) Any eye or Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; Safety eyewear; 4) Services providedas a result of any Workers’ Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; 5) Plano (non-pre-scription) lenses; 6) Non-prescription sunglasses; 7) Two pair of glasses in lieu of bifocals; 8) Services or materials provided by any other group benefit plan providing vision care 9) Ser-vices rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services ren-dered to the Insured Person are within 31 days from the date of such order. 10) Lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Fre-quency when Vision Materials would next become available. Benefits may not be combined with any discount, promotional offering, or other group benefit plans. Standard/PremiumProgressive lens not covered-fund as a Bifocal lens. Standard Progressive lens covered-fund Premium Progressive as a Standard. Underwritten by Fidelity Security Life Insurance Com-pany of Kansas City, Missouri, except in New York. The Certificate of Insurance is on file with your employer. Benefit allowance provides no remaining balance for future use within thesame benefit year. Fees charged for a non-insured benefit must be paid in full to the Provider. Such fees or materials are not covered.

What’s in it for me? Options. It’s simple really. We’re dedicated to helping you see clearly — and that’s why we’ve built a network that gives you lots of choices and flexibility. You can choose from thousands of independent and retail providers to find the one that best fits your needs and schedule. No matter which one you choose, our plan is designed to be easy-to-use and help you access the care you need. Welcome to EyeMed.

Download the EyeMed Members AppIt’s the easy way to view your ID card, see benefit details and find a provider near you.

And now it’s time for the breakdown . . .

Benefits SnapshotExam with dilation as necessary (Once every 12 months)

Frames (Once every 24 months)

Or

Single Vision Lenses (Once every 12 months)

Contacts (Once every 12 months)

With EyeMedOut-of-NetworkReimbursement

$5 Co-pay Up to $35

$0 Co-pay; $100 allowance; 20% off balance over $100 Up to $50

$15 Co-pay Up to $20

$0 Co-pay; $100 allowance; plus balance over $100 Up to $80

Here’s an example of what you might pay for a pair of glasses with us vs. what you’d pay without visioncoverage. So, let’s say you get an eye exam and choose a frame that costs $163 with single vision lensesthat have UV and scratch protection. Now let’s see the difference...

75%SAVINGSwith us*

With EyeMed Without Insurance**

Exam $5 Co-pay Exam $106

Frame $163 Frame $163

-$100 allowance

$63

-$12.60 (20% discount off balance)

$50.40

Lens $15 Co-pay Lens $78$15 UV treatment add-on $23 UV treatment add-on

+$15 Scratch coating add-on +$25 Scratch coating add-on

$45 $126

Total $100.40 Total $395

*This is a snapshot of your benefits. Actual savings will depend on provider, frame and lens selections. **Based on industry averages.

Additional discounts

Take a sneak peek before enrolling

SUMMARY OF BENEFITS

BLM2015

Premium progressives and premium anti-reflective designations are subject to annual review by EyeMed’s Medical Director and are subject to change based on marketconditions. Fixed pricing is reflective of brands at the listed product level . All providers are not required to carry all brands at all levels.

_____________________________ _________________________________________ _________________

ICUBA Buy Up Plan

Vision Care In-Network Out-of-NetworkServices Member Cost Reimbursement

ExamWith Dilation as Necessary $5 Co-pay Up to $35

Retinal Imaging Up to $39 N/A

Frames $0 Co-pay; $130 allowance; 20% off balance over $130 Up to $65

Standard Plastic LensesSingle Vision $15 Co-pay Up to $20Bifocal $15 Co-pay Up to $40Trifocal $15 Co-pay Up to $60Standard Progressive Lens $65 Co-pay Up to $45Premium Progressive Lens $85 Co-pay - $110 Co-payTier 1 $85 Co-pay Up to $45Tier 2 $95 Co-pay Up to $45Tier 3 $110 Co-pay Up to $45Tier 4 $65 Co-pay, 80% of charge less $120 Allowance Up to $45

Lenticular $15 Co-pay Up to $60

Lens Options (paid by the member and added to the base price of the lens)UV Treatment $15 N/ATint (Solid and Gradient) $15 N/AStandard Plastic Scratch Coating $15 N/AStandard Polycarbonate $40 N/AStandard Polycarbonate - Kids under 19 $0 Up to $20Standard Anti-Reflective Coating $45 N/APremium Anti-Reflective Coating $57 - $68 N/ATier 1 $57 N/ATier 2 $68 N/ATier 3 80% of charge N/A

Photochromic/Transitions $75 N/APolarized 20% off retail price N/AOther Add-Ons and Services 20% off retail price N/A

Contact Lens Fit and Follow-Up (Contact lens fit and two follow up visits are available once a comprehensive eye exam has been completed)

Standard Contact Lens Fit & Follow-Up Up to $40 N/APremium Contact Lens Fit & Follow-Up 10% off retail N/A

Contact LensesConventional $0 Co-pay; $130 allowance; 15% off balance over $130 Up to $104Disposable $0 Co-pay; $130 allowance; plus balance over $130 Up to $104Medically Necessary $0 Co-pay, Paid-in-Full Up to $210

Laser Vision CorrectionLasik or PRK from U.S. Laser Network 15% off the retail price or 5% off the promotional price N/A

Hearing CareHearing Health Care from 40% off hearing exams and a low price guarantee N/AAmplifon Hearing Network on discounted hearing aids

FrequencyExamination Once every 12 monthsLenses or Contact Lenses Once every 12 monthsFrame Once every 12 months

40%Complete pairof prescriptioneyeglasses

20%Non-prescriptionsunglasses

20%Remaining balancebeyond plan coverage

These discounts are forin-network providers only

OFF

OFF

OFF

• You’re on the INSIGHTNetwork

• For a complete list ofin-network providersnear you, useour Enhanced ProviderLocator onwww.eyemed.com orcall 1-866-804-0982.

• For Lasik providers, call1-877-5LASER6.

AH2015

Premium progressives and premium anti-reflective designations are subject to annual review by EyeMed’s Medical Director and are subject to change based on marketconditions. Fixed pricing is reflective of brands at the listed product level . All providers are not required to carry all brands at all levels. Benefits are not provided from services ormaterials arising from: 1) Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; 2) Medical and/or surgical treatment of the eye,eyes or supporting structures; 3) Any eye or Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; Safety eyewear; 4) Services providedas a result of any Workers’ Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; 5) Plano (non-pre-scription) lenses; 6) Non-prescription sunglasses; 7) Two pair of glasses in lieu of bifocals; 8) Services or materials provided by any other group benefit plan providing vision care 9) Ser-vices rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services ren-dered to the Insured Person are within 31 days from the date of such order. 10) Lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Fre-quency when Vision Materials would next become available. Benefits may not be combined with any discount, promotional offering, or other group benefit plans. Standard/PremiumProgressive lens not covered-fund as a Bifocal lens. Standard Progressive lens covered-fund Premium Progressive as a Standard. Underwritten by Fidelity Security Life Insurance Com-pany of Kansas City, Missouri, except in New York. The Certificate of Insurance is on file with your employer. Benefit allowance provides no remaining balance for future use within thesame benefit year. Fees charged for a non-insured benefit must be paid in full to the Provider. Such fees or materials are not covered.

What’s in it for me? Options. It’s simple really. We’re dedicated to helping you see clearly — and that’s why we’ve built a network that gives you lots of choices and flexibility. You can choose from thousands of independent and retail providers to find the one that best fits your needs and schedule. No matter which one you choose, our plan is designed to be easy-to-use and help you access the care you need. Welcome to EyeMed.

Download the EyeMed Members AppIt’s the easy way to view your ID card, see benefit details and find a provider near you.

And now it’s time for the breakdown . . .

Benefits SnapshotExam with dilation as necessary (Once every 12 months)

Frames (Once every 12 months)

Or

Single Vision Lenses (Once every 12 months)

Contacts (Once every 12 months)

With EyeMedOut-of-NetworkReimbursement

$5 Co-pay Up to $35

$0 Co-pay; $130 allowance; 20% off balance over $130 Up to $65

$15 Co-pay Up to $20

$0 Co-pay; $130 allowance; plus balance over $130 Up to $104

Here’s an example of what you might pay for a pair of glasses with us vs. what you’d pay without visioncoverage. So, let’s say you get an eye exam and choose a frame that costs $163 with single vision lensesthat have UV and scratch protection. Now let’s see the difference...

81%SAVINGSwith us*

With EyeMed Without Insurance**

Exam $5 Co-pay Exam $106

Frame $163 Frame $163

-$130 allowance

$33

-$6.60 (20% discount off balance)

$26.40

Lens $15 Co-pay Lens $78$15 UV treatment add-on $23 UV treatment add-on

+$15 Scratch coating add-on +$25 Scratch coating add-on

$45 $126

Total $76.40 Total $395

*This is a snapshot of your benefits. Actual savings will depend on provider, frame and lens selections. **Based on industry averages.

Offers from our partners.*Because you’re special.

B-M-1608-458

Book appointment via the phone number or link above to receive

special offer.

Log onto the website listed on the front of your ID card to get

your savings code.

Use code EYEMED2017 in cart. Go to ContactsDirect.com/eyemed to learn more. Offer can apply with or without

vision benefits. Offer may not be combined with other promotions.

SAVE $800

on LASIK at LASIKPLUS

Vision CentersCall 1-855-567-2020

or visit eyemedlasikoffer.com

10% OFF your contact lens purchase

+FREE shipping at ContactsDirect

$20 OFF a purchase, or

$50 OFF purchases of $200 or more

at Sunglass Hut®

Exclusive member offers you don’t want to miss

ENJOY YOUR OWN EYESITE

It’s easy to save with convenient member tools like eyemed.com and the EyeMed Members App. Simply register online or download the app from the App Store or Google Play to see everyday savings and special deals. So you can keep your eyes happy and healthy and save some cash while you’re at it.

Log onto the website listed on your ID card to see more special offers

*This is a sampling of offers available online. Visit the website listed on your ID card for the most current and available offers.

Eyeing new eyewear or contacts? Order online. It’s easy. Choose from hundreds of frames and contact lens brands

Apply your EyeMed benefits in your shopping cart

Enjoy free shipping and returns

Visit any of our online in-network options:*

* You’ll need a valid prescription to process you order. Visit eyemed.com to find an eye doctor near you.

Enjoy the freedom of LASIK and receive exclusive member savings. Leading network of LASIK providers with more than 600

locations nationwide

Exclusive member savings every day with every single provider

5% off promotional pricing

Visit eyemedlasik.com or call 1-800-988-4221.

lenscrafterscontacts.com glasses.com contactsdirect.com

PDF-1603-M-103

How convenient is that?

Using your in-network benefits has never been easierTo satisfy the evolving needs of our members, we’ve added leading online in-network options to our roster of thousands of independent providers and top optical retailers.

ContactsDirect and Glasses.com are the next step in ensuring that you, as an EyeMed member, get fast, easy and convenient access to your benefits.

n Order contact lenses and have them shipped straight to your doorn Use your vision benefits online to make shopping more convenientn Your contact lenses will ship for free, once the prescription is verified

n Access the award-winning 3D virtual try-on appn Choose from a large selection of frames and lenses, including some of the world’s leading brandsn Members can apply in-network vision benefits to their transaction

ContactsDirect

ONLINE, IN-NETWORK OPTIONS

Glasses.comTo purchase contacts or lenses, you’ll need a valid prescription from within the last 12 months. Use our enhanced provider locator at eyemed.com to find an in-network provider for your next eye exam.