Fusion Medical Staffing LLC Vision benefit overview Focus

Fusion Medical Staffing, LLC Vision benefit overview

Focus® featuring VSP network savings annual eye exam § in network: covered in full § out-of-network: up to $45 deductible § in network: $10 § out-of-network: $10

benefit allowances – glasses single vision lenses bifocal lenses trifocal lenses lenticular lenses frames VSP Choice Network out-ofnetwork covered in full $130 up to $50 up to $65 up to $100 up to $70

benefit allowances – glasses VSP Choice Network progressive lenses std. polycarbonate solid plastic dye plastic gradient dye photochromatic lenses scratch resistant anti-reflective coating ultraviolet coating up to contract covered dependents $33 adults $15 (not pink I, II) $17 $31 -$82 $17 -$33 $43 -$85 $16 out-ofnetwork up to lined bifocal allowance no benefit no benefit

benefit allowances – contacts VSP Choice Network fit and follow-up exam elective medically necessary $60 member cost up to $60 up to $170 covered in full out-ofnetwork no benefit up to $105 up to $210 maximum member cost for contact lens exam, fit and follow-up

additional VSP savings 20% off remaining frame balance 20% off non-covered complete prescription glasses 20 -25% off 72, 100 VSP Choice Network access points Based on applicable laws, reduced costs may vary by doctor location. non-covered lens options such as UV coating & polycarbonate 15% off LASIK retail price or 5% off promotional price

example: Jane’s annual vision costs service cost without insurance* VSP insurance pays (Plan 1, in network) Jane pays eye exam $154 $144 $10 single vision $86 lenses $76 $10 frame $200 $130 $56 (after 20% discount) TOTAL $440 $350 $86 check with your VSP provider for cost of services and materials *Cost estimates from All About Vision 2016

example: Sam’s annual vision costs service cost without VSP insurance* pays (Plan 1, in network) Sam pays eye exam $154 $144 $10 contact fitting $150 $60 $90 contacts $220 $130 $90 TOTAL $524 $334 $190 check with your VSP provider for cost of services and materials *Cost estimates from All About Vision 2016

benefit frequencies 12 12 12 months exam months lenses/contacts months frames based on date of service

LASIK and PRK maximum out-of-pocket LASIK $1, 800 per eye LASIK using Wavefront technology $2, 300 per eye PRK $1, 500 per eye Year 3 $1000 VSP offers an average discount of 15% on LASIK and PRK. In order to receive these benefits, a VSP provider must coordinate the procedure.

thank you please check your highlight sheet for details, or contact your human resources department for additional information open enrollment: Nov. 27, 2016 through Dec. 10, 2016 This information is provided by Ameritas Life Insurance Corp. (Ameritas Life). Group dental, vision and hearing care products (9000 Rev. 03 -08, dates may vary by state) and individual dental and vision products (Indiv. 9000 Ed. 11 -09) are issued by Ameritas Life. Ameritas, the bison design, "fulfilling life" and product names designated with SM or ® are service marks or registered service marks of Ameritas Life, affiliate Ameritas Holding Company or Ameritas Mutual Holding Company. All other brands are property of their respective owners. © 2016 Ameritas Mutual Holding Company.