Insurance issued by Principal Life Insurance Company, 711 High Street, Des Moines, IA 50392GP62454-7 1061841 - 10001 Page 1 of 4 05/2023Policyholder: BRAIN DO LLCGroup voluntary visionBenefit summary for active membersYour coverage renews every March 1.What's available to me?Vision insurance is offered through Principal®and VSP®Vision Care. It provides choice, flexibility and savingsthrough a VSP doctor.If you buy this coverage, an established network of VSP doctors will provide quality care for you and yourdependents.VSP choice networkExamsEvery 12 months, one exam is covered in full after $10 copayPrescription glassesLenses - 1 pair covered every12 monthsFrames - covered up to $130every 24 months; 20% offamount over allowance1$25 copay• Single lenses• Lined bifocal lenses• Lined trifocal lenses• Lenticular lenses• Polycarbonate lenses for dependent children under age 18Lens enhancements Standard progressive lenses covered once every 12 months with a $0 copay¹Most other popular lens enhancements are covered after a copay, saving ourmembers an average of 30%¹Elective contactsCovered up to $130 every 12 months. Contact lenses can be chosen insteadof glasses.Contact fitting andevaluationUp to $60 copayNecessary contactsCovered in full after $25 copay every 12 monthsContact lenses can be chosen instead of glasses.1This can vary based on state laws and provider location Savings may not apply at participating retail chains.
Insurance issued by Principal Life Insurance Company, 711 High Street, Des Moines, IA 50392GP62454-7 1061841 - 10001 Page 2 of 4 05/2023Who can buy coverage?• You may buy coverage if you’re an active, full-time employee. Seasonal, temporary, or contract employeescan’t purchase.o If you’re on regularly scheduled day off, holiday, vacation day, jury duty, funeral leave, or personal timeoff, you’re still considered actively at work, as long as you’re fulfilling your regular duties and wereworking the day immediately prior to your time off.o You must enroll within 31 days of being eligible. If you don’t, you’ll have to wait until the next openenrollment period.• If you’re covered, you may buy coverage for your dependents.Additional eligibility requirements may apply.What's the difference between elective and necessary contacts?• Elective - when vision can be corrected by glasses, but contacts are worn.• Necessary - when vision can't be corrected with glasses due to extreme vision problems.Why am I charged an additional copay for contact fitting and evaluation?• Contact lens wearers require an additional evaluation of the eyes’ measurements, and possible follow-upappointments, for fitting and training on proper use of contact lenses.• For these additional services, you won’t pay more than $60 at in-network providers.Are benefits the same for all VSP doctors?• Yes, with the exception of Costco®, Walmart®, and Sam’s Club®. The frame allowance at these locations is$70 which is equivalent to a $130 allowance at other VSP doctor locations. Not all providers atparticipating retail chains are in-network for exam services.• Benefits may also vary by location due to state law.How do I find a VSP doctor?• Visit vsp.com to locate VSP doctors close to you -- or to see if your current eye care professional is in theVSP network.o You’ll need to choose the “Choice” doctor network to view the VSP doctors for your coverage.• Call 800-877-7195.Will I get an ID card?• Yes, your card will have a unique member ID that your doctor will use to verify benefits.Will my doctor submit my claim?• If you’re seeing a VSP doctor, they’ll submit the claim for you.• If you’re seeing someone outside the VSP network, you’re responsible for submitting your own claim. Youcan get that form from vsp.com after logging in as a member using your member ID. Or call 800-877-7195.
Insurance issued by Principal Life Insurance Company, 711 High Street, Des Moines, IA 50392GP62454-7 1061841 - 10001 Page 3 of 4 05/2023Are there any additional savings with VSP?• Glasses and sunglasses - you can save an average of 20-25% off glasses or sunglasses from any VSP doctorwithin 12 months of your last covered vision exam.• Laser vision correction - you pay an average of 15% off the regular price and 5% off the promotional price.You’ll only receive these discounts from contracted clinics. Go to VSP.com and register using your memberID to see the laser vision promotions and find a contracted clinic.These savings can vary based on state laws and provider location.What benefits do I receive if my doctor is outside VSP's network?Covered charges Benefit FrequencyExams Up to $45Once every 12 monthsSingle lenses Up to $30 One pair every 12 monthsLined bifocal lenses Up to $50 One pair every 12 monthsLined trifocal lenses Up to $65 One pair every 12 monthsLenticular lenses Up to $100 One pair every 12 monthsFrames Up to $70One set every 24 monthsElective contacts Up to $105 Contacts are instead of frames and lensesNecessary contactsUp to $210Contacts are instead of frames and lensesWhat are the limitations of my benefits?• Visual analysis or vision aids that aren't medically necessary aren't covered.• No benefits will be paid for:o Non-prescription glasseso Medical or surgical treatment of the eyeso Claims submitted by a doctor who is part of your familyOnce enrolled, you'll receive a booklet with more details regarding your plan limitations and exclusions.
principal.comThis is a summary of vision coverage insured by or with administrative services provided by Principal LifeInsurance Company. This outline is a brief description of your coverage. It is not an insurance contract or acomplete statement of the rights, benefits, limitations and exclusions of the coverage. If there is a discrepancybetween the policy and this document, the actual policy provision prevails. For complete coverage details,refer to the booklet.© 2024 Principal Financial Services, Inc., Principal, Principal and symbol design and Principal Financial Group are trademarks and servicemarks of Principal Financial Services, Inc., a member of the Principal Financial Group.Insurance issued by Principal Life Insurance Company, 711 High Street, Des Moines, IA 50392GP62454-7 1061841 - 10001 Page 4 of 4 05/2023