Summary of Benefits
		Election of Coverage and Eligibility Provisions
		Comprehensive Medical Benefits
		Income Protection Benefit
		Dental Benefit
		Dental Schedule of Benefits
		Prescription Drug Benefit
		Vision Benefit
		Life Insurance & AD&D Benefit
		General Exclusions and Limitations

		How to File a Claim
		When to Call Us
		Request an ID Card
		Continuation of Coverage (COBRA)
		Claim Appeal Procedure
		Coordination of Benefits
		Privacy Practices
		Health Benefits Plan Claim Procedures
		Summary of the Cafeteria Plan
		Forms & Publications

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VISION BENEFIT

Your eligible dependents are covered only if you elected Family Coverage and are working enough hours to qualify for full-time coverage.

Vision benefits help you pay for the cost of eye examinations, frames and lenses for you and your eligible dependents. You must use a licensed ophthalmologist, optometrist or optician to receive benefits under the Plan.

Covered Vision Expenses

Your vision benefit covers examinations, lenses and frames, or contact lenses and is simple to use. The Plan pays 100% of the covered charges, up to a maximum benefit of $135 per person per calendar year.

What's Not Covered

The following expenses are not covered:

• lenses which do not require a prescription
• vision therapy
• procedures for surgical correction of myopia and/or other refractive errors
• anything excluded under the Plan's General Exclusions and Limitations

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