Vision Insurance, continued Preferred Pricing Options, continued Level 1 Progressives Covered in full Up to $40 Level 2 Progressives Covered in full Up to $48 All Other Progressives $140 allowance + Up to $48 up to 20% discount Transitions® (Single Vision/ $70/$80 Multi-Focal) Polarized $75 n/a PGX/PBX $40 Other Lens Options Up to 20% discount* Contact Lenses (In lieu of frame and spectacle lenses) Elective $175 allowance Up to $160 Medically Necessary** Covered in full Up to $250 Refractive Laser Surgery Up to 25% provider Onetime/lifetime $150 allowance Onetime/lifetime $150 discount ¥ Provider discount up to 25%* Frequency Eye Examination Once every 12 months Lenses or contact lenses Once every 12 months Glasses Frames Once every 24 months Vision Premium Cost Employee Only Employee + Employee + Family Child(ren) Spouse/DP Full & Part Time Rates $3.29 $7.16 $6.32 $9.38 | 18 |