San Marcos Unified School District. Open Enrollment October 16, 2017 November 09, 2017 PLEASE READ INSIDE FOR FURTHER DETAILS ABOUT THE

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1 San Marcos Unified School District Open Enrollment October 16, 2017 November 09, 2017 PLEASE READ INSIDE FOR FURTHER DETAILS ABOUT THE Certificated & Management 2018 BENEFIT CHANGES Employees Open Enrollment Guide Important Dates: Site Visits See the Open Enrollment Calendar Walk-In Meetings Can t make it to your site visit? Get your questions answered at the walk-in meetings at the District Office 11/08/17 2:30 P.M. to 5:00 P.M. 11/09/17 2:30 P.M. to 5:00 P.M. (Flu Shots and Last Day of Open Enrollment) Health Fair Questions? Please contact: Kitty Ross Benefits Analyst Phone: Fax: Kitty.ross@smusd.org 10/26/17 at Discovery Elementary 4:00 P.M. 6:00 P.M. Flu Shots, Health Screenings, Healthy Vendors, Raffles

2 2018 Certificated/Mgt Employee Contributions Health Plan/Benefit Packages Payroll Deduction Kaiser Permanente HMO Single 2 Party Family Kaiser $20 (includes Delta PPO, VSP, & Group Life) $0.00 $0.00 $0.00 Kaiser $20 (includes Delta Premier, VSP, & Group Life) $39.55 $39.55 $39.55 Premier Dental Closed to New Enrollments UnitedHealthcare HMO (Package D) Single 2 Party Family Network 1 (includes Delta PPO, VSP, & Group Life) $ $ $ Network 1 (includes Delta Premier, VSP, & Group Life) $ $ $ Premier Dental Closed to New Enrollments UnitedHealthcare HMO (Package D) Single 2 Party Family Network 2 (includes Delta PPO, VSP, & Group Life) $ $ $ Network 2 (includes Delta Premier, VSP, & Group Life) $ $ $ Premier Dental Closed to New Enrollments UnitedHealthcare HMO (Package D) Single 2 Party Family Network 3 (includes Delta PPO, VSP, & Group Life) $ $ $1, Network 3 (includes Delta Premier, VSP, & Group Life) $ $ $1, Premier Dental Closed to New Enrollments Alliance HMO (with $500 HRA) Single 2 Party Family Alliance (includes Delta PPO, VSP, & Group Life) $ $ $ Alliance (includes Delta Premier, VSP, & Group Life) $ $ $ Premier Dental Closed to New Enrollments UnitedHealthcare Choice Plus PPO w/hra Single 2 Party Family PPO (includes Delta PPO, VSP, & Group Life) $ $1, $2, PPO (includes Delta Premier, VSP, & Group Life) $ $1, $2, Premier Dental Closed to New Enrollments

3 OPEN ENROLLMENT FOR CERTIFICATED & MANAGEMENT EMPLOYEES Open enrollment will begin on October 16, 2017 and will end on November 9, Open Enrollment is the time of year employees can change their health plan selection, an opportunity to add or drop eligible dependents, enroll/re-enroll in the Flex 125 plan (FSA), and enroll in other voluntary benefits. Summary of 2018 Plan Changes Certificated & Management employees will be offered the Kaiser $20, UnitedHealthcare HMO Network 1, 2 or 3 Package D, UnitedHealthcare Alliance HMO with $500 HRA, UnitedHealthcare PPO with $500 HRA and Optum Health Chiropractic and Acupuncture. Kaiser Plan $20 No Plan Changes UnitedHealthcare HMO Plan D Network 1, 2, 3 No Plan Changes Alliance Plan Emergency Room Visit From 20% of Out of Pocket Maximum to $300 Copay waived if admitted Alliance Plan HMO with $500 HRA Expanded Medical Groups: Mercy Physicians Medical- Scripps Care Rady Children s Health Network Scripps Clinic Scripps Coastal Medical Center Scripps Physicians Medical Group UCSD Medical Group Searching for UnitedHealthcare HMO providers: Select one of the Performance HMO Networks Search by Doctor or Medical Group UnitedHealthcare Select Plus PPO (SD) 80/50 with $500 HRA A PPO plan that empowers members to choose premium quality providers and lower cost facilities. Premium Tier 1 Network Provider are identified as the highest performing provider in 27 specialties and service. (Note: while oncology and dermatology specialists are not identified in these 27 specialties, if they are automatically included in the Premium Tier 1 network) Network Providers require co-insurance payments (for which you are billed) Outside-Network Providers require higher co-insurance payments (for which you are billed) All UnitedHealthcare participants will receive a new medical ID card(s) for the 2018 Plan year. 1

4 Summary of 2018 Plan Changes - Continued Express Scrips - All UnitedHealthcare Plans On November 1, 2017, Express Scripps Inc. will extend a clinical review process to include certain drugs, including: Long-acting opioids Certain asthma inhalers Drugs for opioid dependence, and Certain anti-clotting medications A review process will require members to change drugs unless their physician documents that the drug is necessary. Express Scripps Inc. (ESI) will notify members directly of the changes. On January 1, 2018, certain members will begin to receive cholesterol drugs through mail/smart 90 for no copay. This is a new recommendation by the US Preventive Services Tasks Force for members that meet the following criteria: Adult age without a history of cardiovascular disease Presence of a health risk factor such as hypertension or smoking Copays are waived only for low/moderate dose cholesterol drugs Not high intensity, which includes (for example, atorvastatin 40mg or rosuvastatin 20-40mg) Express Scripps Advantage Networks (EAN) There are several types of Express Scripts network pharmacies. The copay and coinsurance amounts are based on which network the pharmacy falls under. Members can choose from the following: Short-Term Drugs (up to a 30-day supply) Use Express Scripts Network (EAN) for lowest cost Costco - Rite Aid - Ralphs - Vons - Kmart - Walmart Non EAN Walgreens CVS Target Maintenance Drugs (up to a 90-day supply) Use Smart 90 Pharmacy or Express Scripts Home Delivery for lowest cost Costco Rite Aid or Express Scripts Home Delivery Non EAN Walgreens CVS Target Optum Health for Chiropractic Care and Acupuncture Services Copays will stay the same ($10, $20, or $30) Depending on your Primary Care Physician copay Only Optum chiropractors and acupuncturists are eligible for reimbursement under the plan Unlimited visits (subject to medical necessity) and X-rays as authorized. To locate a provider: 1) Go to the Provider Locator search at: ca.com look for VEBA in the column heading 2) Call Optum Member Services at ) Call the provider directly to schedule an appointment, and verify they are part of the Optum network for VEBA 2

5 FLEXIBLE SPENDING ACCOUNTS/SECTION 125 PLANS Enrollment is not continuous - employees that wish to enroll in this plan must re-enroll every year This is the time to enroll, or re-enroll if you currently participate, in the flexible spending account program. This plan allows you to pre-tax income for dependent care reimbursement and medical expenses. To enroll or re-enroll in the plan, employees must meet with a representative from American Fidelity. Representatives will be available at every Open Enrollment site visit, the walk-in meetings at the District Office and at the Health/Benefit Fair. VOLUNTARY PLAN ENROLLMENTS The following plans are available for enrollment during Open Enrollment. If you are interested in these plans, please request additional information or visit the SMUSD website*. Legal Aid Plan Long Term Care Insurance Voluntary Life Insurance Critical Illness Insurance Liberty Mutual Home, Renters, and Auto Insurance American Fidelity Plans Please see an American Fidelity representative Accident Insurance Disability Insurance Cancer Insurance Life Insurance Getting Your Questions Answered Please visit the SMUSD website for additional information. The website includes supplementary information regarding all of the plans. Go to click on Departments, Benefits, Open Enrollment. Come to a Site Visit: Please see the Open Enrollment calendar for the dates and times. Walk-In Meetings at the District Office: Can t make it to your site visit? Get your questions answered at the walk-in basis meetings at the District Office. The meetings will be in the Human Resources Conference room (2 nd floor) on the following dates: October 26 th Annual Health Fair 4:00 PM to 6:00 PM Discovery Elementary 730 Applewilde San Marcos CA November 8 th 2:30 PM to 5:00 PM District Office November 9 th 2:30 PM to 5:00 PM District Office (Flu Shots available and Last Day of Open Enrollment) 3

6 How to Make Changes Employees do not have to complete an enrollment if they are not making any changes ONLINE ENROLLMENT: Employees can enroll in any of the health plans (health plans only) by using the VEBA online enrollment tool. If enrolling in a UnitedHealthcare plan you will need to have your primary care doctor name and medical group ID# for yourself and or your dependents. Click on the Online Enrollment link. The link says, VEBA Members: Click here to Enroll Online. Enter your Pin and Password. If you forgot your pin and password or do not have one, click on the link that says New to Online Enrollment or forgot your Login Information? Then follow the instructions on the screen To Search for UnitedHealthcare HMO providers: Select one of the Performance HMO Networks and Search by Doctor or Medical Group PAPER ENROLLMENT FORM: Print a paper enrollment form from the SMUSD website or pick one up at your Open Enrollment site visit. ADDING NEW DEPENDENTS: Health Plan To add an eligible dependent to your medical health plan, please use the Online Open Enrollment Tool or print a paper enrollment form from the SMUSD website. Send proof of dependent eligibility to HR-Benefits or upload when enrolling online. Delta Plan To add an eligible dependent to your Delta Dental plan, please complete an enrollment/change form. Employees can print the form from the SMUSD website. Dependent children age must be unmarried full time students to be eligible to be enrolled in the dental, vision or group life insurance plans. Dependent children age 25+ are not eligible for the dental, vision or group life insurance. Vision Plan No form needed for adding a dependent to Vision, dependents enrolled in Dental will be auto enrolled in the Vision Service Plan. Group Life Insurance To update your beneficiary for your District life policy go the SMUSD website to print the beneficiary change form. CHANGING YOUR DELTA PREMIER DENTAL PLAN TO THE DELTA PPO PLAN: The Delta Dental Premier plan has been closed to new enrollments since 2004 Employees can change to the Delta PPO plan. Please print an enrollment form from the SMUSD website or pick one up from your site visit. Once enrolled in the PPO plan Employees cannot switch back to the Premier plan Employees can verify which Delta Dental plan they have by calling Delta Dental or by registering at, Delta Dental Phone Number Health Care Reform - Affordable Care Act: The Affordable Care Act allows young adults to stay on their parent s health plan until age 26. The dependent does not have to be a full-time student and marital status does not prohibit the dependent s eligibility. The Affordable Care Act rule only applies to medical health care coverage. ALL ENROLLMENT FORMS MUST BE RECEIVED BY NOVEMBER 9, NO EXCEPTIONS 4

7 Eligible Dependents Eligible dependents include: Your spouse/domestic partner Your eligible children Medial Health Plan: Young adult health insurance coverage has been extended to eligible dependents up to age 26. Eligible dependents are not required to be full-time students to be covered on the employee s health plan. An eligible dependent can be married and is eligible to be covered on the employee s health plan. Dental, Vision & Group Life: Your unmarried children who are between the ages of 19 and 24, and are full-time students carrying at least 12 units at an accredited college, university, or a State Department of Education-approved vocational/technical school. Your unmarried children who are deemed disabled by their physician and approved by your carrier. The disability must have occurred prior to age 19. Eligible children include: Your natural and adopted children Stepchildren, if you are married to your stepchildren s parent. If you and your spouse divorce, your former dependent stepchildren are no longer eligible for coverage Children of your domestic partner. If you and your domestic partner separate, the children of your former domestic partner are no longer eligible for coverage Children for whom you have permanent legal guardianship issued by a court of law Your children who must be covered under a Qualified Medical Child Support Order Stepchildren who must be covered under a Qualified Medical Child Support Order Dependent Eligibility Verification Documents Please note: Employees are required to provide documentation when adding a new dependent to their benefits. For new dependents, dependent eligibility documentation must be turned in by the Open Enrollment deadline, November 9, Spouse Birth Child Step Children Adopted, Foster Children, or Legal Guardianship Dental, Vision & Life Over age dependents (age 19-24) Domestic Partner Marriage Certificate or first page of 2015 or 2016 tax forms Birth Certificate or first page of 2015 or 2016 tax forms Birth certificate of stepchild listing employee s current spouse as the parent of the stepchild. Court documents showing legal responsibility for the child(ren). Birth certificate or first page of 2015 or 2016 tax form And School transcripts for the most recent semester showing enrollment in at least 12 semester units or the college s full-time qualifying units. Domestic Partner Registration (Domestic Partners cannot be of the opposite sex unless one is over the age of 62.) State California guidelines web site may be found at: SMUSD Open Enrollment Plan Year 2018

8 SAN MARCOS UNIFIED SCHOOL DISTR ICT: Certif icated/management YOUR 2018 BENEFIT OPTIONS Your district offers a number of different medical options. Please review the following information to help select the best plan for you and your family CHANGES SELECTING YOUR PLAN Each of the available medical options covers a different network of doctors and may not offer coverage outside of that network. UHC SignatureValue Alliance plan's Emergency Room copay is changing to $300 per visit The Express Scripts plans will include additional preventive medications at no cost to the member based on recommendations by the US Preventive Task Force. This applies to adults age with a health risk factor such as hypertension or smoking, but no history of cardiovascular disease. Performance HMO Medical groups are ranked in three networks based on quality scores from the California Office of the Patient Advocate (opa.ca.gov) and what they charge for services. Copays vary by network. Medical groups in Network 1 have the highest performance ratings and lowest copays. HMO Plans In an HMO, you must see your Primary Care Physician (PCP) first for most medical issues. Your PCP will refer you to any specialists you may need to see. When selecting your plan, remember: You and your dependents must enroll in the same network but can select different PCPs within that network Your network election is effective for the entire year you may change PCPs within the network but you cannot change networks until the next enrollment period Kaiser A high quality HMO program that utilizes the Kaiser Permanente network of hospitals and physicians. 1 2 SignatureValue Alliance HMO This HMO benefit plan is a health plan that offers access to physicians selected based on their ability to guide their patients to the care and resources that help promote better health outcomes and lower costs. This plan combines a high-deductible health plan with a VEBA-funded account that helps members meet your deductible. Members can use your HRA funds immediately to help cover the initial deductible expenses PPO Plans In a PPO, the plan offers both in-network and out-of-network coverage. You can see any doctor but will pay less when you use doctors in the UHC Select Plus network. For the lowest out-ofpocket costs, be sure to select a Tier 1 designated provider or facility. AVAILABLE PLANS Kaiser HMO UHC Performance HMO D Network 1 Network 2 Network 3 UHC SignatureValue Alliance HMO UHC PPO UHC Medical Plans In an HMO, you see your PCP first for most medical issues. You do not need a referal for mental health, chiropractic or OBGYN services. To find a provider or facility: 1. Go to Welcometouhc.com/csveba 2. Scroll down to choose from the plan options 3. Choose the appropriate network and click Search the network 4. Click okay 5. Click continue 6. Search by Name, Specialty, or Medical Group FINDING A DOCTOR OR FACILITY Chiropractic/Acupuncture (See plan summary for availability) Provided by OptumHealth Physical Health of California providers, which has more than 2,700 network providers in California. Three ways to find a provider: Go to the Provider Locator search at myoptumhealthphysicalhealthofca.com and select "Provider Locator". Choose "California Schools VEBA" from the dropdown menu for Plan/Product Call Optum Member Services at (5 a.m. to 5 p.m., Pacific Time, Monday - Friday) for the most current and up to date information Call the provider directly to schedule an appointment and verify they are part of the Optum network for VEBA. California Schools VEBA Making Health Care Better for Everyone vebaonline.com

9 EXPRESS SCRIPTS UHC members get their Rx benefits through Express Scripts. Your copay and coinsurance amounts are based on where you fill your prescriptions. Non-EAN pharmacies will charge an additional $5 copay per prescription. For the lowest copays, be sure to utilize an Express Scripts Advantage Network (EAN) pharmacy. If you continue to use a retail pharmacy after 3 fills of your medication, then you will pay the maintenance copay for a 30-day supply. Short-Term Drugs (up to a 30-day supply) Use Express Scripts Advantage Network (EAN) pharmacy (for lowest cost) or non - EAN pharmacy Costco VONS Ralphs EAN Pharmacies Haggen Rite Aid Kmart Many Independent Pharmacies Non-EAN Pharmacies Maintenance Drugs (up to a 90-day supply) Use Express scripts Smart90 pharmacy or Express Scripts Home Delivery for lowest cost Costco Rite Aid Smart90 Pharmacies Express Scripts Home Delivery Walgreens CVS Target Many Independent Pharmacies ADDITIONAL VEBA SERVICES VEBA Advocacy: When your doctor or health plan can t help you, call VEBA s Advocacy Office. They ll help you resolve benefit issues. Employee Assistance Program: Get through life s challenges with counseling, budgeting, and legal advice, child and eldercare support, and more. Best Doctors: Started by Harvard doctors, Best Doctors gives you access to medical experts to make sure you have the right diagnosis and treatment for your situation at no cost to you. Benefit Best Doctors Employee Assistance Program CONTACTS Website Bestdoctors.com LiveandWorkWell.com Access: VEBA Phone Express Scripts Express-Scripts.com Kaiser KP.org * Brand Deductible Applies: $250/Individual and $500/family Optum Health MyOptumHealthPhysicalHealthofCA.com (Chiropractic/Acupuncture) UHC members pay standard copays plus $5/prescription at a non-ean pharmacy (non-ean pharmacies include CVS, Target, Walgreens, and certain independent pharmacies) 2 UHC members pay the Retail Refill Allowance (RRA) penalty (equal to 2 times short-term medication copay for 30-day supply) if you fill maintenance prescriptions at a network pharmacy other than Smart90. UnitedHealthcare (UHC) MyUHC.com Services must be medically necessary and may be subject to prior authorization from OptumHealth Disclaimer: This summary is merely a brief description of the major benefits of the plan(s) and is not intended to alter or expand benefits, right, or liabilities as set forth in the official plan documents and contracts. Limitations may apply. See the Certificate/Evidence of Coverage for details. California Schools VEBA Making Health Care Better for Everyone vebaonline.com

10 Keep Smiling Delta Dental PPO SM Save with PPO Visit a dentist in the PPO 1 network to maximize your savings. 2 These dentists have agreed to reduced fees, and you won t get charged more than your expected share of the bill. 3 Find a PPO dentist at deltadentalins.com. 4 Set up an online account Get information about your plan anytime, anywhere by signing up for an Online Services account at deltadentalins.com. This free service, available once your coverage kicks in, lets you check benefits and eligibility information, find a network dentist and more. Check in without an ID card You don t need a Delta Dental ID card when you visit the dentist. Just provide your name, birth date and enrollee ID or social security number. If your family members are covered under your plan, they will need your information. Prefer to take a paper or electronic ID card with you? Simply sign in to Online Services, where you can view or print your card with the click of a button. Coordinate dual coverage If you re covered under two plans, ask your dental office to include information about both plans with your claim, and we ll handle the rest. Understand transition of care Did you start on a dental treatment plan before your PPO coverage kicked in? Generally, multistage procedures are only covered under your current plan if treatment began after your plan s effective date of coverage. 5 You can find this date by logging in to Online Services. Newly covered? Visit deltadentalins.com/welcome. Save with a PPO dentist PPO NON PPO 1 In Texas, Delta Dental Insurance Company offers a Dental Provider Organization (DPO) plan. 2 You can still visit any licensed dentist, but your out-of-pocket costs may be higher if you choose a non-ppo dentist. Network dentists are paid contracted fees. 3 You are responsible for any applicable deductibles, coinsurance, amounts over plan maximums and charges for non-covered services. 4 We recommend verifying before each appointment that your dentist is a PPO dentist. 5 Applies only to procedures covered under your plan. If you began treatment prior to your effective date of coverage, you or your prior carrier is responsible for any costs. Group- and state-specific exceptions may apply. Enrollees currently undergoing active orthodontic treatment may be eligible to continue treatment under Delta Dental PPO. Review your Evidence of Coverage, Summary Plan Description or Group Dental Service Contract for specific details about your plan. LEGAL NOTICES: Access federal and state legal notices related to your plan at deltadentalins.com/about/legal/index-enrollee.html. Copyright 2016 Delta Dental. All rights reserved. HL_PPO #96083E (rev. 5/16)

11 Plan Benefit Highlights for: San Marcos Unified School District (Active & COBRA) Group No: & Eligibility Primary enrollee, spouse and eligible dependent children to age 19 or to age 25 if dependent is full-time student Maximums Waiting Period(s) $1,750 per person each calendar year Basic Svcs. Major Svcs. None None Prosthodontics None Orthodontics None Benefits and Covered Services* Diagnostic & Preventive Services (D & P) Exams, two cleanings, x-rays, sealants Basic Services Fillings, simple tooth extractions Endodontics (root canals) Covered Under Basic Services Periodontics (gum treatment) Covered Under Basic Services Oral Surgery Covered Under Basic Services Major Services Crowns, inlays, onlays and cast restorations Prosthodontics Bridges, dentures and implants Orthodontic Benefits Dependent children to age 19 only Orthodontic Maximums Delta Dental PPO dentists** Non-Delta Dental PPO dentists** 100 % 100 % 100 % 100 % 100 % 100 % 100 % 100 % 100 % 100 % 100 % 100 % 50 % 50 % 50 % 50 % $ 1,000 Lifetime $ 1,000 Lifetime Dental Accident Benefits 100 % (separate $1,000 maximum per person each calendar year) Temporomandibular Joint (TMJ) Benefits 70 % ($300 lifetime maximum per person) 100 % (separate $1,000 maximum per person each calendar year) 70 % ($300 lifetime maximum per person) * Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist s submitted fees. ** Reimbursement is based on PPO contracted fees for PPO dentists, PPO contracted fees for Premier dentists and PPO contracted fees for non-delta Dental dentists. Delta Dental of California 100 First St. San Francisco, CA Customer Service deltadentalins.com Claims Address P.O. Box Sacramento, CA This benefit information is not intended or designed to replace or serve as the plan s Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company s benefits representative. HLT_PPO_2COL_DDC (Rev. 10/16) CA- MX

12 Protect your vision with VSP. Get the best in eyecare and eyewear with San Marcos Unified School District and VSP Vision Care. At VSP, we invest in the things you value most the best care at the lowest out-of-pocket costs. Because we re the only national not-for-profit vision care company, you can trust that we ll always put your wellness first. You ll like what you see with VSP. Value and Savings. You ll enjoy more value and the lowest out-of-pocket costs. High Quality Vision Care. You ll get the best care from a VSP provider, including a WellVision Exam the most comprehensive exam designed to detect eye and health conditions. Plus, when you see a VSP provider, your satisfaction is guaranteed. Choice of Providers. The decision is yours to make choose a VSP provider or any out-of-network provider. Great Eyewear. It s easy to find the perfect frame at a price that fits your budget. See why we re consumers #1 choice in vision care 2. Contact us vsp.com Using your VSP benefit is easy. Register at vsp.com Once your plan is effective, review your benefit information. Find an eyecare provider who s right for you. To find a VSP provider, visit vsp.com or call At your appointment, tell them you have VSP. There s no ID card necessary. If you d like a card as a reference, you can print one on vsp.com. That s it! We ll handle the rest there are no claim forms to complete when you see a VSP provider. Choice in Eyewear From classic styles to the latest designer frames, you ll find hundreds of options. Choose from featured frame brands like Anne Klein, bebe, Calvin Klein, Flexon, Lacoste, Nike, Nine West, and more 1. Visit vsp.com to find a VSP provider who carries these brands.

13 Your VSP Vision Benefits Summary San Marcos Unified School District and VSP provide you with an affordable eyecare plan. Benefit WellVision Exam Description Your Coverage with a VSP Provider Focuses on your eyes and overall wellness VSP Provider Network: VSP Choice Copay Frequency $10 for exam and glasses Every 12 months Prescription Glasses Frame $130 allowance for a wide selection of frames $150 allowance for featured frame brands 20% savings on the amount over your allowance $70 Costco frame allowance Combined with exam Every 12 months Lenses Lens Enhancements Single vision, lined bifocal, and lined trifocal lenses Polycarbonate lenses for dependent children Standard progressive lenses Premium progressive lenses Custom progressive lenses Average savings of 20-25% on other lens enhancements Combined with exam $55 $95 - $105 $150 - $175 Every 12 months Every 12 months Contacts (instead of glasses) $130 allowance for contacts and contact lens exam (fitting and evaluation) 15% savings on a contact lens exam (fitting and evaluation) $0 Every 12 months Primary Eyecare Treatment and diagnosis of eye conditions like pink eye, vision loss and monitoring of cataracts, glaucoma and diabetic retinopathy. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details. $5 As needed Extra Savings Glasses and Sunglasses Extra $20 to spend on featured frame brands. Go to vsp.com/specialoffers for details. 20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within 12 months of your last WellVision Exam. Retinal Screening No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam Laser Vision Correction Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities Your Coverage with Out-of-Network Providers Visit vsp.com for details, if you plan to see a provider other than a VSP network provider. Exam... up to $40 Frame... up to $45 Single Vision Lenses... up to $40 Lined Bifocal Lenses... up to $60 Lined Trifocal Lenses... up to $80 Progressive Lenses... up to $80 Contacts... up to $105 VSP guarantees coverage from VSP network providers only. Coverage information is subject to change. 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. Contact us vsp.com 1 Brands/Promotion subject to change. 2 Blueocean Market Intelligence National Vision Plan Member Research, Vision Service Plan. All rights reserved. VSP, VSP Vision care for life, and WellVision Exam are registered trademarks of Vision Service Plan. Flexon is a registered trademark of Marchon Eyewear, Inc. All other company names and brands are trademarks or registered trademarks of their respective owners.