50 WEST FALL CREEK PARKWAY NORTH DRIVE INDIANAPOLIS, INDIANA P

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1 April 2014 Dear Ivy Tech Employee/Retiree, Ivy Tech Community College of Indiana is delighted to offer you comprehensive vision coverage through VSP Vision Care. The benefit plan gives you great savings on prescription glasses and contacts. Additionally, you will receive personalized care focused on your eye health and overall wellness. If you are currently enrolled through Ivy Tech, you don t have to do a thing to keep your comprehensive vision coverage through VSP Vision Care. Your membership will automatically renew unless you specifically elect not to renew. Premiums for this benefit are solely paid by the employee/retiree and will be direct billed to you. VSP accepts checks, automatic withdrawal from your checking account, and credit cards. You can also securely and conveniently manage your payment account online at vsp.com. Monthly, quarterly, and annual rates are enclosed in this enrollment packet. If you have any questions, visit vsp.com/go/ivytech or call VSP at Sincerely, Jennifer Fisher Executive Director of Employee Benefits 50 WEST FALL CREEK PARKWAY NORTH DRIVE INDIANAPOLIS, INDIANA P Ivy Tech is an accredited, equal opportunity, affirmative action community college.

2 Keep your eyes healthy with Ivy Tech Community College and VSP Vision Care. Why enroll in VSP? Your eyes deserve the best care to keep them healthy year after year. Plus with VSP, you ll get a great value on your eyecare and eyewear. You ll like what you see with VSP. Personalized Care. You ll get quality care that focuses on your eyes and overall wellness through a WellVision Exam from a VSP doctor. When you see a VSP doctor, you ll get the most out of your benefit and have lower out-of-pocket costs. Plus with a VSP doctor your satisfaction is guaranteed if you re not 100% happy, we ll make it right. Great Eyewear. Choose the eyewear that s right for you andyour budget. Choice of Providers. With open access to see any eyecare provider, you can see the one who s right for you. Choose a VSP doctor or any other provider. Save with VSP coverage: Without VSP Coverage With VSP Coverage Eye Exam $155 $15 Copay Frame $130 Bifocal Lenses $148 $20 Copay Progressive Lenses $154 $105 Transitions Lenses $101 $70 Member-only Annual Contribution N/A $96 Total $688 $306 *Comparison based on national averages for comprehensive eye exams and most commonly purchased brands. Average Annual Savings $382 with a VSP Doctor with a VSP Doctor Enrolling in VSP is easy. Choose one of these convenient options: Online: Visit VSP at vsp.com/go/ivytech and complete the online enrollment form. Mail: Complete the enclosed VSP enrollment form and mail in the postage-paid return envelope. Phone: Call VSP at and speak with a member services representative, Monday-Friday, 5:00 a.m. 8:00 p.m. Saturday, 7:00 a.m. - 8:00 p.m., Sunday, 7:00 a.m. - 7:00 p.m. Pacific Choice in Eyewear From classic styles to the latest designer frames, you ll find hundreds of options. Choose from featured frame brands like bebe, ck Calvin Klein, Flexon, Lacoste, Michael Kors, Nike, Nine West, and more. Visit vsp.com to find a doctor who carries these brands. Save Big on Hearing Aids Save up to an average of 50% on all-digital hearing aids through TruHearing. Visit specialoffers.vsp.com/truhearing for details. Enroll in VSP today. You ll be glad you did. vsp.com/go/ivytech

3 Your VSP Vision Benefits Summary Ivy Tech Community College and VSP provide you with an affordable eyecare plan. VSP Doctor Network: VSP Choice Coverage Effective: July 1, 2014 Visit vsp.com/go/ivytech for more details on your vision benefit and for exclusive savings and promotions for VSP members. Benefit Description Your Coverage with VSP Doctors WellVision Exam Focuses on your eyes and overall wellness $15 Copay Frequency Frequency Prescription Glasses Frame Lenses Lens Enhancements $130 allowance for a wide selection of frames $150 allowance for featured frame brands 20% savings on the amount over your allowance $20 Single vision, lined bifocal, and lined trifocal lenses Scratch-resistant coating Standard progressive lenses $55 Premium progressive lenses $95-$105 Custom progressive lenses $150-$175 Average savings of 20-25% on other lens enhancements other Contacts (instead of glasses) $130 allowance for contacts Contact lens exam (fitting and evaluation). This additional exam ensures proper fit of your contacts. If you choose contact lenses, you will be eligible for a frame one from the date the contact lenses were obtained. Up to $60 for fitting & evaluation Diabetic Eyecare Plus Program Services related to types 1 and 2 diabetes. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details. $20 As needed Extra Savings Your Monthly Contribution Your Quarterly Contribution Your Yearly Contribution Glasses and Sunglasses 20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP doctor within 12 months of your last WellVision Exam. Laser Vision Correction Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities. $ Employee/Retiree Only $ Employee/Retiree + Child(ren) $ Employee/Retiree + Spouse $ Employee/Retiree + Family $ Employee/Retiree Only $ Employee/Retiree + Child(ren) $ Employee/Retiree + Spouse $ Employee/Retiree + Family $ Employee/Retiree Only $ Employee/Retiree + Child(ren) $ Employee/Retiree + Spouse $ Employee/Retiree + Family Your Coverage with Other Providers Visit vsp.com/go/ivytech for details, if you plan to see a provider other than a VSP doctor. Exam... up to $45 Single Vision Lenses...up to $30 Lined Trifocal Lenses...up to $65 Contacts...up to $105 Frame... up to $70 Lined Bifocal Lenses...up to $50 Progressive Lenses...up to $50 Visit VSP guarantees vsp.com coverage for details, from if VSP you doctors plan to only. see Coverage a provider information other is than subject a to VSP change. doctor. In the event of a conflict between this information and your organization s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location. * Plan year is from July 1 through June 30 Dependent children may be covered up to the end of the month in which the child turns 26.

4 Additional Information Please Note: By enrolling in this voluntary plan, you agree to the outlined terms for a twelve (12) month period, July 1, 2014 through June 30, 2015, unless there s an IRS Section 125 qualified permitting event. Your VSP membership will automatically renew effective July 1, 2015, unless you specifically elect not to renew. You ll be billed directly by VSP. Uncollected premiums for two consecutive months will result in the termination of your VSP benefit and could result in collection action for any unpaid premiums. Keep your eyes healthy and your vision clear with VSP. Enroll Today Vision Service Plan. All rights reserved. VSP, Vision care for life, and WellVision Exam are registered trademarks of Vision Service Plan. All other brands or marks are the property of their respective owners. VSP Vision Care JOB#16206CM 3/14

5 VSP Vision Care Open Enrollment Enrollment or Change Form Enrollment Code: Only complete this form to enroll or to make changes if you haven t done so online or by phone. Complete, sign, and date this form. Print all information clearly, in capital letters, using BLUE or BLACK ink. Fill in the applicable circles completely ( ). List all dependents you wish to be covered on the plan. Your coverage tier and rate are determined by the number of dependents you enroll. See your brochure for plan and rate details. Mail to VSP in the enclosed preaddressed, postage-paid envelope. Need to update your contact information? If so, note your changes below: A D D R E S S L I N E 1 Select all that apply: m Enroll/update my coverage. m Update my address/ . m Submit/update my payment information. m Cancel my coverage. Your VSP Rates Dependent Relationship Key C Child T Student H Disabled Dependent P Domestic Partner S Spouse A D D R E S S L I N E 2 C I T Y S T Z I P Please provide your address to receive an electronic confirmation: E M A I L Please provide your phone number: ( P H O ) N E # - Covered Dependent Name Gender Date of Birth Relationship to Enrollee For additional dependents please, use back of form. By signing below, I agree that all information is true and accurate. I understand that I am enrolling in this voluntary plan as described in the benefit document within for a twelve (12) month period. I understand my VSP plan will automatically renew unless I specifically elect not to renew. Enrollee Signature Date Attn: Client Administrative Services, MS 229 PO Box Sacramento, CA Vision Service Plan. All rights reserved. VSP and Vision care for life are registered trademarks of Vision Service Plan. F-H CAT#00752 JOB#7183CM 8/11 Enrollment Code: Select one of the following payment options: (See back of form for additional payment options.) Automatic Checking Withdrawal (Please include a voided check.) Payment Frequency: m Annually m Quarterly m Monthly Bank Name Account Holder Name F I R S T L A S T Checking Account # Routing # (9-digit # on bottom left side of check) By signing below, I agree that all information is true and accurate. I authorize VSP to debit my account in accordance with the instructions included, on or after the fifteenth (15 th ) of the month preceding my enrollment effective date. I understand that my payment arrangements will automatically continue upon renewal unless I specifically elect to make changes. I understand that failure to submit premiums by the coverage date will result in the termination of the plan and may result in collection action for unpaid premiums. Account Holder Signature Date

6 Covered Dependent Name Gender Date of Birth Relationship to Enrollee Credit Card Payment Frequency: m Annually m Quarterly m Monthly Card Type: m Visa m MasterCard Cardholder Name Credit Card # Expiration Date / Check Enclosed (Make Payable to VSP) Payment Frequency: m Annually m Quarterly m Monthly Check # Check Amount $.