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• Aphakia. • Anisometropia. • Aniseikonia. • Aniridia. • Corneal disorders. • Post-traumatic disorders. • Irregular astigmatism. Prescription eyewear rider exclusions • Low vision aids. • Non-prescription products (other than eyeglass frames), such as eyeglass holders, eyeglass cases, repair kits, contact lens cases, contact lens cleaning and wetting solution, and lens protection plans. • Non-prescription sunglasses. • Optometric vision therapy and orthoptics (eye exercises). • Plano contact lenses or glasses (non-prescription). • Professional services for evaluation, fitting and follow-up care for contact lenses, except that this exclusion does not apply to medically necessary contact lenses. • Replacement of lost, broken, or damaged lenses or frames. RSAVX2CY0124 2

Kaiser Permanente NW Senior Advantage EOC (2024) - Page 169 Kaiser Permanente NW Senior Advantage EOC (2024) Page 168 Page 170