Protect your vision with VSP

1 Protect your vision with VSP .. Get the best in eye care and eyewear with State of California and VSP vision Care. K\m Ybfc`` ]b JGD3 KY ]bjYgh ]b h\Y h\]b[g mci jU`iY . acgh [fYUh WUfY Uh `ck cih!cZ!dcW_Yh Wcghg" 6 YWUigY kY . UfY h\Y cb`m bUh]cbU` bch!Zcf!dfcZ]h j]g]cb WUfY WcadUbm mci Active Employee WUb hfigh h\Uh kY k]`` U`kUmg dih mcif kY``bYgg Z]fgh" . 9bfc`` ]b h\Y JGD DfYa]Yf D`Ub" . You'll like what you see with VSP. Mci k]`` VY [`UX mci X]X" . High Quality vision Care. Mci k]`` [Yh h\Y VYgh WUfY Zfca U JGD dfcj]XYf 7cbhUWh ig" . ]bW`iX]b[ U KY``J]g]cb 9lUa h\Y acgh WcadfY\Ybg]jY YlUa XYg][bYX ghUhYcZWUYad`cmYY"jgdZcfaY"Wca hc XYhYWh YmY UbX \YU`h\ WcbX]h]cbg". Choice of Providers. H\Y XYW]g]cb ]g mcifg hc aU_Y W\ccgY U JGD Using your VSP benefit is easy. XcWhcf U dUfh]W]dUh]b[ fYhU]` W\U]b cf Ubm cih!cZ!bYhkcf_ dfcj]XYf". Create an account at CbWY. Great Eyewear. =h ]g YUgm hc Z]bX h\Y dYfZYWh ZfUaY Uh U df]WY h\Uh Z]hg mcif d`Ub ]g YZZYWh]jY fYj]Yk mcif VYbYZ]h mcif ViX[Yh" ]bZcfaUh]cb".

2 Find an eye care provider who is right Save with VSP Without VSP With VSP With VSP for you. Hc Z]bX U JGD dfcj]XYf j]g]h coverage:* Coverage Basic Plan Premier Plan cf WU`` 9mY 9lUa %+% %$ 7cdUm %$ 7cdUm At your appointment, tell them you have VSP. H\YfY ]g bc =8 WUfX bYWYggUfm" =Z mci AUhYf]U` 7cdUm $ &) 7cdUm &) 7cdUm kci`X `]_Y U WUfX Ug U fYZYfYbWY mci WUb &$$ FYhU]` :fUaY &$$ %00 $ df]bh cbY Uh ". 6]ZcWU` @YbgYg $ $ That is it! We will handle the rest h\YfY UfY . %)$. bc W`U]a Zcfag hc Wcad`YhY k\Yb mci . GhUbXUfX Dfc[fYgg]jY gYY U JGD dfcj]XYf". -- )) $ . @YbgYg Dc`mWUfVcbUhY . *) ') %) Look into the @YbgYg VSP Premier Plan! D\chcW\fca]W Mci k]`` Yb^cm Ub YjYb f]W\Yf VYbYZ]h k]h\ h\Y . %%, $ $. 5 XUdh]jY @YbgYg JGD DfYa]Yf D`Ub". 9ad`cmYY!Cb`m &$$ ZfUaY U``ckUbWY. B#5 $ %$*"$, 5bbiU` DfYa]ia :i``m WcjYfYX ghUbXUfX dfc[fYgg]jY. Total Out-of- $,$' $225 $ `YbgYg Pocket Cost 7cadUf]gcb VUgYX cb bUh]cbU` UjYfU[Yg Zcf ($ )$ Zcf dfYa]ia dfc[fYgg]jY `YbgYg WcadfY\Ybg]jY YmY YlUag UbX acgh Wcaacb`m Average Annual Average Annual difW\UgYX VfUbXg UbX aUm bch fYZ`YWh mcif Savings with VSP Savings with VSP -) %&$ Zcf Wighca dfc[fYgg]jY `YbgYg UWhiU` YldYf]YbWY" Basic Plan: Premier Plan: 7cdUmg Udd`m hc dfYa]ia UbX Wighca Bc acfY h\Ub '- Zcf fYh]bU` gWfYYb]b[.

3 Dfc[fYgg]jY `YbgYg" . $57,.00 $6(*.92. Corrected Employee vision Benefits Summary VSP Coverage Effective Date: 01/01/2019. Open Enrollment: 09/10/2018 - 10/05/2018. State of California and VSP provide you with a choice of affordable vision plans choose the one that is right for you. VSP Basic Plan VSP Provider Network: VSP Advantage VSP Premier Plan VSP Provider Network: VSP Choice Bene t Description Copay Bene t Description Copay your Coverage with a VSP Provider your Coverage with a VSP Provider Focuses on your eyes and Focuses on your eyes and WellVision WellVision overall wellness $10 overall wellness $10. Exam Exam Every calendar year Every calendar year Prescription Glasses Prescription Glasses $75 allowance for a wide selection $200 allowance for a wide of frames selection of frames $95 allowance on featured $220 allowance on featured Frame frame brands frame brands Frame 20% savings on the amount over $110 allowance at Costco . your allowance $25 20% savings on the amount over $25.)

4 Every calendar year your allowance Every calendar year Single vision , lined bifocal, and lined Single vision , lined bifocal, and lined Lenses trifocal lenses Lenses trifocal lenses Every calendar year Every calendar year Tints/photochromic adaptive lenses $0 Tints/photochromic adaptive lenses $0. Polycarbonate lenses for $0 Polycarbonate lenses for $0. dependent children dependent children Lens Polycarbonate lenses for adults $31 $35 Lens Polycarbonate lenses for adults $15. Enhancements Standard progressive lenses $55 Enhancements Standard progressive lenses $0. Premium progressive lenses $95 $105 Premium progressive lenses $40 $50. Custom progressive lenses $150 $175 Custom progressive lenses $95 $120. 5jYfU[Y gUj]b[g cZ &$ &) cb Average savings of 20 25% on ch\Yf `Ybg Yb\UbWYaYbhg other lens enhancements $%%$ allowance for exam, contacts $200 allowance for contacts and and contact lens exam ( tting contact lens exam ( tting and Contacts Contacts and evaluation) evaluation). (instead of $0 (instead of $0.)]

5 15% savings on contact lens exam 15% savings on contact lens exam glasses) glasses). ( tting and evaluation) ( tting and evaluation). Every calendar year Every calendar year Glasses and Sunglasses Glasses and Sunglasses 20% savings on additional glasses and 20% savings on additional glasses and sunglasses, including lens enhancements, from sunglasses, including lens enhancements, from any VSP provider within 12 months of your last any VSP provider within 12 months of your last WellVision Exam WellVision Exam Extra Savings Bc acfY h\Ub U '- WcdUm cb fcih]bY fYh]bU` Extra Savings No more than a $39 copay on routine retinal gWfYYb]b[ Ug Ub Yb\UbWYaYbh hc U KY``J]g]cb 9lUa screening as an enhancement to a WellVision Exam Laser vision Correction Laser vision Correction Average 15% o the price or 5% o the Average 15% o the price or 5% o the promotional price; discounts only available from promotional price; discounts only available from contracted facilities contracted facilities your Monthly $0 Employee Only your Monthly $ Employee Only Contribution $0 Employee + One Dependent Contribution $ Employee + One Dependent $0 Employee + Family $ Employee + Family your Coverage with Out-of-network Providers your Coverage with Out-of-network Providers Visit for details, if you plan to see a provider other than a VSP Visit for details, if you plan to see a provider other than a VSP.

6 Advantage network provider. Choice network provider. Exam .. up to $35 Lined Trifocal Lenses..up to $50 Exam .. up to $45 Lined Trifocal Lenses ..up to $65. Frame .. up to $40 Progressive Lenses ..up to $50 Frame .. up to $70 Progressive Lenses..up to $50. Single vision Lenses .. up to $25 Contacts ..up to $110 Single vision Lenses .. up to $30 Contacts ..up to $105. Lined Bifocal Lenses ..up to $50 Tints ..up to $5 Lined Bifocal Lenses ..up to $50 Tints ..up to $5. Coverage information is subject to change. In the event of a con ict between this Coverage information is subject to change. In the event of a con ict between this information and your organization's contract with VSP, the terms of the contract will information and your organization's contract with VSP, the terms of the contract will prevail. prevail. Based on applicable laws, bene ts may vary by location. Based on applicable laws, bene ts may vary by location. The employee monthly contribution re ects your contribution to the VSP Premier Plan The state contributes $ toward your vision plan, the equivalent of the VSP Basic Plan cost.

7 The state contributes $ toward your vision plan, the equivalent of the VSP Basic cost. Both deductions are itemized on the warrant stub to verify that the deductions Plan cost. Both deductions are itemized on the warrant stub to verify that the deductions occurred and were paid to VSP. occurred and were paid to VSP. 1. Brand/Promotions subject to change. 2018 vision Service Plan. All rights reserved. VSP, 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. 9231 VCCM [Revised 9/28/18].