Vision Plan Highlights Vision VSP Full Feature – Choice B Employee Only $2.52 Employee + Spouse $4.77 Employee + Child(ren) $4.86 Family $7.69 Plan Provisions VSP Full Feature – Choice B In - Network Out - of - Network Exam $20 copay Up to $39 off Frames $130 allowance, then 20% off remaining balance Up to $46 off Lenses • Single vision • Bifocal • Trifocal • Lenticular $20 copay Up to $ 23 off Up to $ 37 off Up to $ 49 off Up to $ 64 off Contact Lenses (Medically necessary) $20 copay Up to $210 off Elective Contact Lenses (in lieu of glasses) $130 allowance Up to $130 off Frequency • Exam • Lenses • Frames • Contact lenses Once every 12 months Once every 12 months Once every 24 months Once every 12 months