VISION BENEFITS FOR:RON HOOVER RV & MARINE CENTERSEFFECTIVE DATE: January 01, 2024 CLASS: 1 All FT Eilgible Employees Vision benefit plans are administered by VSP. VSP and WellVision Exam are registered trademarks, VSP Primary EyeCare Plan is a servicemark of Vision Service Plan. Flexon is a registered trademark of Marchon Eyewear, Inc. All other brands or marks are the property of their respective owners. NOTE: This is not a policy and the descriptions of the policy(ies) are in summary form. If a discrepancy exists, the policy(ies) will control in all instances. For a complete description of benefits, exclusions, limitations, reduction of benefits, and/or terms under which the policy(ies) may be continued in force or discontinued, please refer to the policy(ies). VISION BENEFIT HIGHLIGHTSVision (Voluntary)IN-NETWORK COVERAGEBENEFIT TYPE DESCRIPTION COPAY(1)FREQUENCYWellVision Exam●Focuses on your eyes and overall wellness$10 12 monthsPrescription Glasses$25 See Frames & Lenses..Frames●$120 allowance for a wide selection of frames(4)●20% savings on the amount over your retail allowance(3)Copay included inprescription glasses24 months..Lenses●Single Vision/Lined Bifocal/Lined Trifocal lenses●Polycarbonate lenses for dependent childrenCopay included inprescription glasses12 months..Lens Enhancements●Standard/Premium/Custom Progressive Lenses●Savings of 20-25% on other lens enhancements(3)STAND. / PREM. / CUST.$55 / $95 - $105 / $150 - $17512 monthsContacts●Contact Lenses coverage instead of Prescription GlassesSee Evaluation & Fitting 12 months..Evaluation & Fitting●Elective Contact Lenses●Member receives 15% off of contact lens exam services;(3)Up to $60(evaluation & fitting)12 months..Contact Lenses●$120 allowance for Elective Contact lenses●Medically Necessary Contact lenses covered in full at VSPdoctor locationsN/A 12 monthsADDITIONAL SAVINGS..Primary EyeCare..PlanSM (1)$10 copay per visit at VSP doctors. Provides covered in full retinal screening for members with diabetes who do not have diabetic eye disease.(Additional exams and service for members with diabetes, glaucoma, or age-related macular degeneration. Treatment and diagnoses of eyeconditions, including pink eye, vision loss, and cataracts available for all members.)(8)..Low VisionSupplemental testing covered every two years. 75% coverage for approved low vision aids, up to $1,000 (less any amount paid for supplementaltesting) every two years at VSP doctors..Glasses/..Sunglasses(7)Members receive an extra $20 to spend on Featured Frame Brands including bebe, Calvin Klein, Cole Haan, Dragon®, Flexon®, Lacoste, Nike,and more. Go to vsp.com/specialoffers for details.(5)..ContactsGet exclusive offer(s) on eligible elective contacts at VSP network doctors. Visit vsp.com/offers for more information.(6)..Retinal ScreeningNo more than $39 copay on routine retinal screening as an enhancement to a WellVision Exam..Laser Vision CorrectionAverage 15% off regular price or 5% off the promo price; discounts only available from contracted facilities(9)..Additional OffersVSP’s offers a variety of additional savings . Go to vsp.com/offers for detailsOUT-OF-NETWORK COVERAGE:(11) Exam: Up to $45.00 | Frame: Up to $70.00 | Contacts: Up to $105 ($210 if medically necessary)(10)LENSES: Single: Up to $30.00 | Lined Bifocal: Up to $50.00 | Lined Trifocal: Up to $65.00 | Progressive: Up to $50.00 | Lenticular: Up to $100.00REAL PROVIDER CHOICES(1)Your employees can choose their provider from more than 112,000 access points, including the largest national network of independent doctors andnearly 26,200 participating retail chain access points.** Find an eye doctor at MyRenProviders.com.VSP Doctors: 80% offer early morning, evening and weekend hours. 24-hour access to emergency care.Participating Retail Chains(1,10): Your employees get the convenience of popular retail chains like these and more.
VISION BENEFITS FOR:RON HOOVER RV & MARINE CENTERSEFFECTIVE DATE: January 01, 2024 CLASS: 1 All FT Eilgible Employees Vision benefit plans are administered by VSP. VSP and WellVision Exam are registered trademarks, VSP Primary EyeCare Plan is a servicemark of Vision Service Plan. Flexon is a registered trademark of Marchon Eyewear, Inc. All other brands or marks are the property of their respective owners. NOTE: This is not a policy and the descriptions of the policy(ies) are in summary form. If a discrepancy exists, the policy(ies) will control in all instances. For a complete description of benefits, exclusions, limitations, reduction of benefits, and/or terms under which the policy(ies) may be continued in force or discontinued, please refer to the policy(ies). ADDITIONAL VISION PROPOSAL INFORMATIONIn addition to the exclusions and limitations set forth in the Vision Benefit Highlight sheets, the following additional proposal information applies to all Visionplans. Some brands of spectacle frames may be unavailable for purchase as Benefits, or may be subject to additional limitations. Covered Persons may obtaindetails regarding frame brand availability from their In-Network Provider.(12)(1) When covered-in-full services are obtained from a VSP network provider, the patient will have no out-of-pocket expense other than any applicable copays.Services and eye-wear obtained through out-of- network providers are subject to product availability and the same copays and limitations.(2) Based on applicable laws, benefits may vary by location.(3) Walmart and Costco published prices already include discounts instead of those noted.(4) Retail equivalent of $70 at participating Walmart and Costco locations for $120 retail frame allowance.(5) Reflects current promotion, evaluated annually. Promotion/featured frame brands are subject to change and the promotional allowance does not apply atWalmart and Costco. In the event of a conflict between this information and your organization’s contract with VSP, the terms of the contract will prevail.(6) Offer(s) subject to change.(7) 20% off applies to unlimited additional pairs of glasses valid through any VSP network provider within 12 months of the last covered eye exam.(8) The VSP Primary EyeCare Plan pays secondary to other medical eye insurance coverage.(9) Custom LASIK coverage only available using wavefront technology with the microkeratome surgical device. Other LASIK procedures may be performed at anadditional cost to the member. Laser VisionCare discounts are only available from VSP-contracted facilities.(10) Participating retail chains upon request. Benefits may vary at participating retail chain locations.(11) Services and eyewear obtained through out-of-network providers are subject to product availability and the same copay and frequency limitations as servicesand eyeware obtained in-network.(12) Coverage shall be governed solely by the terms of your Renaissance contract.EXCLUSIONS AND LIMITATIONS:PATIENT OPTIONS: This Plan is designed to cover visual needs rather than cosmetic materials. When the Covered Person selects any of the following extras,the Plan will pay the basic cost of the allowed lenses or frames, and the Covered Person will pay the additional costs for the options. (E1) Optional cosmeticprocesses (E2) Anti-reflective coating (E3) Color coating (E4) Mirror coating. (E5) Scratch coating (E6) Blended lenses (E7) Cosmetic lenses (E8) Laminatedlenses (E9) Oversize lenses (E10) Polycarbonate lenses (E11) Photochromic lenses, tinted lenses except Pink #1 and Pink #2, may or may not be included. Pleaserefer to your certificate. (E12) Progressive multifocal lenses (E13) UV (ultraviolet) protected lenses (E14) Certain limitations on low vision care.NOT COVERED: There are no Benefits for professional services or materials connected with: (N1) Orthoptics or vision training and any associatedsupplemental testing. (N2) Plano lenses (less than a ± .50 diopter power). (N3) Two pair of glasses in lieu of bifocals. (N4) Replacement of lenses and framesfurnished under this Plan that are lost or broken, except at the normal intervals when services are otherwise available. (N5) Medical or surgical treatment ofthe eyes. (N6) Corrective vision treatment of an Experimental Nature. (N7) Costs for services and/or materials above stated allowances. (N8) Services and/ormaterials not indicated on this Schedule as covered Plan Benefits. (N9) Contact lens modification, polishing or cleaning (N10) Local, state and/or federal taxes,except where RLHICA or its claims administrator is required by law to pay. (N11) Replacement of lost or damaged contact lenses, except at the normal intervalswhen services are otherwise available.