Balanced Care Vision Choice Meeting Vision Insurance Needs with a Range of Choices

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Laurel Singleton
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1 Balanced Care Vision Choice Meeting Vision Insurance Needs with a Range of Choices STANDARD INSURANCE COMPANY

2 Quality Vision Coverage With the workforce aging and computer use an everyday reality, Vision insurance is a key component of a robust benefits package. Employees stay healthier because they are more likely to seek out preventive care. Employers look better to potential hires because they can offer more comprehensive benefits. Vision insurance represents a relatively small cost, yet it provides a benefit that many employees can use. Standard Insurance Company offers three Vision plans to help employers balance features and cost and to meet the diverse needs of their employees. All three plans provide benefits for groups as small as 10 employees. As always, all three plans are backed by our commitment to excellent customer service. Balanced Care Vision SM Plan I VSP Vision Care s nationwide network of doctors is the basis for this plan. * It provides employees with network discounts and a large doctor directory. Balanced Care Vision SM Plan II With this plan, employees are offered the convenience of the EyeMed Vision Care Access nationwide network, which includes some of the largest optical retailers in the U.S., including LensCrafters, Sears Optical, Target Optical, JCPenney Optical and most Pearle Vision SM locations. Balanced Care Vision SM Plan III Our most flexible plan eliminates surprises. The simple schedule of benefits allows employees to choose any vision- care provider and still know what is covered. * VSP is a registered trademark of Vision Service Plan.

3 Balanced Care Vision Plan I Benefits VSP Doctor Out-of-Network Annual Eye Exam 100 percent covered * covers up to $52 Single Vision Lenses 100 percent covered * covers up to $55 Bifocal Lenses 100 percent covered * covers up to $75 Trifocal Lenses 100 percent covered * covers up to $95 Lenticular Lenses 100 percent covered * covers up to $125 Frame covers up to $120 covers up to $45 Contact Lenses covers up to $120 covers up to $105 * Subject to deductible. Plan Specifics VSP provides up to $120 toward a new frame. Members receive a 20 percent discount off the excess amount for any frame that exceeds the allowance Members pay a $10 annual deductible on exams and $25 annual deductible on materials Information about medically necessary contacts is available in the Exclusions and Limitations section of this document Frequency for Exam/Lenses/Frame is 12/12/24 months With the 12/12/24 frequency: Contacts are in lieu of eyeglasses; normal frequency rules apply (selecting contacts does not reset the frame frequency, as contacts and frame frequencies work independently) Other Benefits with a VSP Doctor Enjoy 20 percent off additional non-covered complete pairs of prescription glasses and sunglasses For contacts, receive 15 percent off your contact lens fitting and follow-up Get special pricing on lens options such as ultra-violet coating, progressive lenses, etc. For LASIK or Photorefractive Keratectomy (PRK), save an average of 15 percent off the usual and customary price or 5 percent off the promotional price with VSP and a contracted laser surgery center Find a VSP doctor at or call VSP at Monthly Rates Voluntary Employer-paid or w/dental Employee $ 9.48 $ 7.96 Employee+ 1 dependent Employee+ 2 or more dependents Rates are valid for policy effective dates through 1/1/09 and are guaranteed for two years, or to align with Section 125 plan year.

4 Balanced Care Vision Plan II Benefits EyeMed Network Out-of-Network Annual Eye Exam 100 percent covered covers up to $35 Single Vision Lenses 100 percent covered covers up to $25 Bifocal Lenses 100 percent covered covers up to $40 Trifocal Lenses 100 percent covered covers up to $55 Frame covers up to $110 covers up to $45 Contact Lenses covers up to $115 covers up to $100 Plan Specifics EyeMed Vision Care provides up to $110 toward a new frame. If the member exceeds this allowance, he will receive a 20 percent discount off the excess amount Members pay a $10 annual deductible on exams and $25 annual deductible on eyeglass lenses Information about medically necessary contacts is available in the Exclusions and Limitations section of this document Frequency for Exam/Lenses/Frame is 12/12/24 months With the 12/12/24 frequency: Contacts are in lieu of eyeglasses; normal frequency rules apply (selecting contacts does not reset the frame frequency, as contacts and frame frequencies work independently) This plan is not available for groups sitused in Maine, Maryland and Massachusetts Other Benefits Get up to 40 percent off of additional purchases of complete glasses Enjoy 20 percent off of items not fully covered by the plan Get 15 percent off any remaining amount that exceeds the conventional contact lenses allowance Contact lens exam, fit and follow-up have a maximum member cost of $55 Special pricing on lens options such as ultra-violet coating For LASIK and PRK, save 15 percent off the retail price or 5 percent off the promotional price with U.S. Laser Network owned by LCA-Vision Find a provider at or call EyeMed at Monthly Rates Voluntary Employer-paid or w/dental Employee $ 7.48 $ 5.96 Employee+ 1 dependent Employee+ 2 or more dependents Rates are valid for policy effective dates through 1/1/09 and are guaranteed for two years, or to align with Section 125 plan year.

5 Balanced Care Vision Plan III Benefits Annual Eye Exam covers up to $50 Single Vision Lenses covers up to $40 Bifocal Lenses covers up to $60 Trifocal Lenses covers up to $75 Progressive Lenses covers up to $80 Lenticular Lenses covers up to $80 Frame covers up to $80 Contact Lenses covers up to $100 In the Balanced Care Vision Plan III, covered benefits are the same no matter which provider you choose. Plan Specifics The member will be responsible for any deductible, if applicable, and any cost over the specified plan benefits Plan includes a calendar year deductible of $20 for exam/materials Frequency for Exam/Lenses/Frame is 12/12/24 months With the 12/12/24 frequency: Contacts are in lieu of eyeglasses; normal frequency rules apply (selecting contacts does not reset the frame frequency, as contacts and frame frequencies work independently) Other Benefits Choose any vision-care provider Employees pay for all services, then submit a claim to us for reimbursement Claims are reimbursed based on a schedule of benefits, so your employees know precisely how much is covered ahead of time Monthly Rates Voluntary Employer-paid or w/dental Employee $ 5.48 $ 3.96 Employee+ 1 dependent Employee+ 2 or more dependents Rates are valid for policy effective dates through 1/1/09 and are guaranteed for two years, or to align with Section 125 plan year.

6 Details for All Vision Plans Employer funding is not required. If no employer money is involved, it is assumed the eyecare plan will be sold in conjunction with a bona fide cafeteria plan regulated by Section 125 of the Internal Revenue code, and it must meet all Section 125 requirements. The rates and benefits quoted are based on a minimum of 10 enrolled employees. All rates and benefits quoted are not valid if the final enrollment is below the minimum threshold. No benefits are payable for a service that is not listed under the list of eyecare services found in the certificate. Benefits are available for all full-time, active employees working at least 30 hours per week who have completed the designated eligibility waiting period. This form highlights the Vision coverage available through Standard Insurance Company. Please refer to the Certificate of Insurance for a complete list of covered procedures. Exclusions and Limitations Balanced Care Vision Plan I Covered Expenses will not include, and no benefits will be payable for, expenses incurred for: Vision examinations more than once in any 12-month period. Lenses more than once in any 12-month period, and then only if replacement is deemed necessary by the provider. Frames more than once in any 24-month period, and then only if replacement is deemed necessary by the provider. Contact lenses more than once in any 12-month period. When chosen, contact lenses shall be in lieu of any other lens or frame benefit during the 12-month period. When lenses and frames are chosen, expenses for contact lenses are not covered expenses during the 12-month period. Medically necessary contact lenses, except for the first $105 of expense, when such lenses are purchased for any reason other than for the following conditions: - following cataract surgery - to correct extreme visual problems that cannot be corrected with spectacle lenses - certain conditions of anisometropia - keratoconus Medically necessary contact lenses are limited to the plan allowance (100 percent covered in-network, $210 out-of-network). Such payment is limited to once in any 12-month period and is in lieu of lenses and frame benefits under this policy. Orthoptics or eye care training and any associated testing. Plano lenses. Two pairs of glasses in lieu of bifocals. Lenses and frames that are lost or broken, except at the normal intervals when services are otherwise available. Medical or surgical treatment of the eyes. Services for which a claim is filed more than 180 days after completion of the service. The following materials, over and above the covered expense for the basic material. These materials are cosmetic and the insured will be responsible for the cost of these materials. - blended lenses - oversize lenses - photo chromatic lenses; tinted lenses except pink numbers 1 and 2

7 Progressive multi-focal lenses. The coating of the lens or lenses. The laminating of the lens or lenses. Frames exceeding the maximum allowance selected by the policyholder. Balanced Care Vision Plan II This product is not valid for groups sitused in Maine, Maryland and Massachusetts. Please check for availability in your state. Covered Expenses will not include, and no benefits will be payable for, expenses incurred for: Vision examinations more than once in any 12-month period. Lenses more than once in any 12-month period. Frames more than once in any 24-month period. Contact lenses more than once in any 12-month period. When chosen, contact lenses shall be in lieu of any other lens benefit during the 12-month period. When eyeglass lenses are chosen, expenses for contact lenses are not covered expenses during the 12-month period. Contacts limited to the amount shown on the plan highlights page unless they are medically necessary. Contact lenses are defined as medically necessary if the individual is diagnosed with one of the following conditions: - Keratoconus, where the patient is not correctable to 20/30 in either or both eyes using standard spectacle lenses - high Ametropia, exceeding -12 D or +9 D in spherical equivalent - anisometropia of 3 D or more patients whose vision can be corrected two lines of improvement on the visual acuity chart when compared to best corrected standard spectacle lenses. If the insured is diagnosed with a medically necessary condition, the provider will submit a request for preauthorization to EyeMed. The Medical Director reviews all requests for medically necessary contact lenses. If approved, the insured will be covered for medically necessary contact lenses up to the plan allowance (100 percent covered in-network, $200 out-of-network). Orthoptics or eyecare training and any associated testing. Plano non-prescription lenses and non-prescription sunglasses (except for 20 percent discount). Two pairs of glasses in lieu of bifocals. (Does not apply to secondary discounts). Lenses and frames that are lost or broken, except at the normal intervals when services are otherwise available. Medical and/or surgical treatment of the eye, eyes or supporting structures. Balanced Care Vision Plan III Covered Expenses will not include, and no benefits will be payable for, expenses incurred for: Vision examinations more than once in any 12-month period. Lenses more than once in any 12-month period. Frames more than once in any 24-month period. Contact lenses more than once in any 12-month period. When chosen, contact lenses shall be in lieu of any other lens or frame benefit during the 12-month period. When lenses and frames are chosen, expenses for contact lenses are not covered expenses during the 12-month period. Examinations performed or frames or lenses ordered before the insured was covered under the eyecare expense benefits. Subject to extension of benefits, any examination performed or frame or lens ordered after the insured s coverage under the eyecare expense benefits ceases. Sub-normal eyecare aids; orthoptic or eyecare training or any associated testing. Non-prescription lenses. Replacement or repair of lost or broken lenses or frames except at normal intervals. Any eye examination or corrective eyewear required by an employer as a condition of employment. Medical or surgical treatment of the eyes. Any service or supply not shown on the Schedule of Eye Care Procedures. Coated lenses; oversize lenses (exceeding 71mm); photo-gray lenses; polished edges; UV-400 coating and facets, and tints other than solid.

8 Standard Insurance Company Founded in Portland, Oregon in 1906, The Standard is a nationally recognized insurance provider offering group disability, life, dental and vision insurance and individual disability insurance. We provide insurance to more than 28,500 groups covering approximately 7.6 million employees nationwide. * Our first group policy, written in 1951 and still in force today, stands as a testament to our commitment to building long-term relationships. We always strive to do what s right for our policyholders and their employees. This dedication has resulted in a national reputation for quality products, superior service and industry expertise. To learn more about Vision insurance from The Standard, contact your insurance advisor, call the Employee Benefits Sales and Service Office for your area at or visit us at * As of March 31, 2008, based on internal data developed by Standard Insurance Company. Standard Insurance Company 1100 SW Sixth Avenue Portland OR SI (6/08)PR/ER 9000 Ed

Balanced Care VisionSM. Choice. Options to Help Your Employees Stay Focused at Work

Balanced Care VisionSM. Choice. Options to Help Your Employees Stay Focused at Work Balanced Care VisionSM Choice Options to Help Your Employees Stay Focused at Work Standard Insurance Company The Standard Life Insurance Company of New York Standard Insurance Company is licensed to issue