1 VOLUNTARY VISION BENEFITS For the employees of Whitewater Unified School District Effective

Why vision insurance? 73% of the U.S. population aged 18 or older require some form of correction 30 million Americans wear contact lenses Glaucoma affects 3 million Americans 13 million Americans suffer from macular degeneration Eye exams are important in the diagnosis and treatment of diabetes

VISION EXAM Covered once every 12 months 3 Plan design In-NetworkOut-of-Network Paid in fullUp to $35

FRAMES Covered once every 12 months * Then 20% off balance Frames and eyeglass lenses are in lieu of the contact-lens benefit. 4 Plan design In-NetworkOut-of-Network Up to $150*Up to $75

LENSES Covered once every 12 months Frames and eyeglass lenses are in lieu of the contact-lens benefit. 5 Plan design In-NetworkOut-of-Network SinglePaid in FullUp to $25 BifocalPaid in FullUp to $40 TrifocalPaid in FullUp to $55 Progressive 100% after $65 copay No benefit

CONTACT LENSES *Then 15% off conventional contact lenses 6 Plan design Covered once every 12 months Contact lenses are in lieu of the frame-and-eyeglass benefit. Elective In-NetworkUp to $150* Out-of-Network Up to $120 Necessary In-NetworkPlan pays 100% Out-of-NetworkUp to $200

Members can apply allowance toward any frame at any participating provider Designed to minimize member out-of-pocket cost See any vision provider (better benefits for in network providers) Freedom of choice – no frame collections Contact-lens fitting and follow-up fees are separate from the contact-lens allowance Why DeltaVision?

DeltaVision savings Type of Service/ Discount Average Retail Cost DeltaVision covers Member Out- of-Pocket Cost Frames ($150 allowance) $150 $0 Spectacle lenses (single-vision) $67 $0 Lens Options: UV Coating $21$6$15 Standard Scratch- Resistance $23$8$15 Anti-Reflective Coating $66$21$45 TOTAL$307$232$75 Significant reduction in out-of-pocket costs, for example:

MONTHLY PREMIUMS (Payroll-deducted on a pretax basis) Single: $9.85 Limited Family: $18.76 Family: $29.43 Rates are guaranteed through June 30, Your Cost

Delta Dental vision providers within a 30-mile radius of Whitewater include: Network vision providers – Shopko Optical (Fort Atkinson, Delavan) – Milton Vision Center (Milton) – Sears Optical (Janesville) – Dr. John E. Hall (Elkhorn) – Morrison Eye Clinic (Delavan) – Eye Physicians & Surgeons SC (Elkhorn) – JC Penney Optical (Janesville) – Lenscrafters (Janesville) Find providers fast at

11 Vision- provider search Start here You can also receive provider information by calling EyeMed at

When seeing a network vision provider: – Show your ID card, or provide name and date of birth – Reference your group – Ask if procedures will be covered – Make sure they are filing the claims For instructions when seeing a non-network provider or general questions, call EyeMed at (6:30 a.m. -10 p.m. Central Time Monday-Saturday and 10 a.m.-7 p.m. Central Time Sunday) Using network vision providers