EYEMED VOLUNTARY VISION PLAN Services EyeMed Network Frequency Benefit Out-of-Network ▪ EyeMed Well Vision Exam 12 Months $10 Copay Up to $40 Reimbursement Prescription Glasses Plan $130 Allowance + 20% off ▪ 5/1/2021 – 4/30/2022 Eyeglass Frames 12 Months the Balance Up to $91 Reimbursement Eyeglass Lenses Provider Search Single Vision 12 Months $10 Copay Up to $30 Reimbursement www.eyemed.com Bifocal Vision 12 Months $10 Copay Up to $50 Reimbursement Additional Information Trifocal Vision 12 Months $10 Copay Up to $70 Reimbursement ▪ Benefit Summary Contact Lenses Elective 12 Months $130 Allowance + 15% off Up to $130 Reimbursement the Balance Necessary 12 Months Covered in Full Up to $210 Reimbursement Additional Benefits Additional Lens enhancements and eyewear discounts available from EyeMed. 19 19