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Employee Vision Care Benefit Plan Summary
Effective July 1, 2008

$1,000 Benefit Maximum per Member per Calendar Year

Your Vision Plan covers these benefits:

Vision Examination,
including glaucoma screening (tonometry test)

One examination per calendar year for participants under 19 years of age

One examination every other calendar year for participants 19 years of age and older

Lenses
 (clear single vision, clear bifocal or clear trifocal)

Limited to the usual and customary charge

Lenses allowed once per calendar year for participants under 19 years of age

Lenses allowed every other calendar year for participants 19 years of age and older

Frames

Allowed every othr calendar year, limited to $80 maximum benefit

Contact Lenses

Up to the maximum benefit allowance for frames and clear single vision lenses, as optometrically necessary
 
  This chart represents a brief explanation of the covered services and payment levels. It should not be used to determine whether your vision expenses would be paid. The written benefit plan governs the benefits available.  For further details of the coverage, including exclusions, any reductions or limitations and the terms under which the benefit plans may be continued, see your Benefit Summary Plan Description.