Vision

Vision Insurance Fact Sheet

Benefits at a Glance

Effective January 1, 2009, some benefits and co-pays are changing and monthly premium rates are decreasing.

Coweta School System employees are able to use EyeMed Vision Care as their provider for quality eye care services. EyeMed Vision Care's Network consists of private practicing optometrists, ophthalmologists, opticians, and the nation's leading optical retailer, LensCrafters ® . Their eye care professionals are looking forward to meeting your vision care needs.

Receiving your vision benefit is as easy as visiting your EyeMed provider. To locate providers, call 1-866-939-3633 and use EyeMed's locator service or speak with an EyeMed Customer Service Representative or visit their website at http://www.eyemedvisioncare.com/ .

Vision Care Services
Member Cost

Out-of-Network

Exam with Dilation as Necessary
$10 Copay

$35

Exam Options:

Standard Contact Lens Fit and Follow-Up:
Up to $40

N/A

Premium Contact Lens Fit and Follow-Up:
10% off Retail

N/A

Frames: Any available frame at provider location
$0 Copay; $130 Allowance, 20% off balance over $130

$60

Standard Plastic Lenses

Single Vision

$25 Copay

$25

Bifocal

$25 Copay

$40

Trifocal

$25 Copay

$55

Lenticular

$25 Copay

$55

Standard Progressive**

$90

$40

Premium Progressive**

$90, 80% of Charge less $120 Allowance

$40

Lens Options:

UV Treatment

$15

N/A

Tint (Solid and Gradient)

$15

N/A

Standard Plastic Scratch Coating

$15

N/A

Standard Polycarbonate

$40

N/A

Standard Anti-Reflective Coating

$45

N/A

Other Add-Ons and Services

20% off Retail Price

N/A

Contact Lenses

(Contact lens allowance includes materials only)

Conventional

$0 Copay; $130 allowance, 15% off balance over $130

$110

Disposable

$0 Copay; $130 allowance, plus balance over $130

$110

Medically Necessary

$0 Copay, Paid-in-Full

$200

Frequency:

Examination

Once every 12 months

Frame

Once every 24 months

Lenses or Contact Lenses

Once every 12 months

Monthly Rate

Subscriber

$6.09

Subscriber + Family

$14.48

** Standard/Premium Progressive lenses not covered - fund as a Bifocal Lens

Additional Discounts:

Member receives a 20% discount on items not covered by the plan at network Providers, which cannot be combined with any other discounts or promotional offers. Discount does not apply to EyeMed Provider's professional services, or contact lenses.

Members also receive 15% off retail price or 5% off promotional price for Lasik or PRK from the US Laser Network, owned and operated by LCA Vision.

Members also receive a 40% discount off complete pair eyeglass purchases and a 15% discount off conventional contact lenses once the funded benefit has been used.

After initial purchase, replacement contact lenses may be obtained via the Internet at substantial savings and mailed directly to the member. Details are available at www.eyemedvisioncare.com.

Fidelity Security Life Policy number VC-19/VC-20, form number M-9059

Plan Exclusions:

1) Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; 2) Medical and/or surgical} treatment of the eye, eyes or supporting structures;

3) Any eye or Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; Safety eyewear

4) Services provided as a result of any Workers' Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof;

5) Plano (non-prescription) lenses and/or contact lenses; 6) Non-prescription sunglasses; 7) Two pair of glasses in lieu of bifocals;

8) Services or materials provided by any other group benefit plan providing vision care; 9) Certain brand name Vision Materials in which the manufacturer imposes a no-discount policy;

10) Services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the insured Person are within 31 days from the date of such order.

11) Lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available.

Getting an eye exam is more than just testing your vision. Eye exams can assist in the early detection of vision conditions and health conditions such as:

Glaucoma

Diabetes

Cataracts

High Blood Pressure

Astigmatism

That's why it's important to get an eye exam on a regular basis. Children need eye exams, too! Did you know the American Optometric Association recommends that children receive an eye exam as early as six months of age? Our nationwide provider network will be happy to assist you in servicing your vision care needs.

**LASIK and PRK Benefit

EyeMed is pleased to provide all EyeMed Vision Care members with a laser vision correction benefit. EyeMed and LCA-Vision have arranged to provide his benefit to all EyeMed Vision Care members through the U.S. Laser Network. Members are entitled to a 15% discount on the usual and customary fees for LASIK and PRK procedures, or a 5% discount on any promotional pricing, whichever is the greater benefit. One easy phone call to 1-877-5LASER6 begins the process of using your benefit. No claim forms are needed, making it a hassle free process for members.

Your EyeMed benefit also provides for continued savings through our Premier Plus Secondary Purchase Plan. After your initial benefits have been utilized, you are able to receive ongoing discounts on additional eyewear purchases at EyeMed provider locations, which result in discounts up to 45% off the retail price of eyewear and accessories. See your EyeMed provider for details.

Contact Lens By Mail Program

You may order replacement contact lenses for competitive prices via the internet, and have the contacts mailed directly to your home. The service is for replacement contact lenses only, and your core benefit allowance or discount will not apply to the service. Your initial pair of contact lenses must still be purchased from your eye care provider to ensure proper fit and follow-up care. Simply visit www.eyemedvisioncare.com for details, and a link to the order site.

Underwritten by Fidelity Security Life Insurance Company. The Certificate of Insurance is on file with your employer. Contact your employer to review a copy.

Vision Care Services	Member Cost	Out-of-Network

Exam with Dilation as Necessary	$10 Copay	$35

Exam Options:

Standard Contact Lens Fit and Follow-Up:	Up to $40	N/A
Premium Contact Lens Fit and Follow-Up:	10% off Retail	N/A

Frames: Any available frame at provider location	$0 Copay; $130 Allowance, 20% off balance over $130	$60

Standard Plastic Lenses
Single Vision	$25 Copay	$25
Bifocal	$25 Copay	$40
Trifocal	$25 Copay	$55
Lenticular	$25 Copay	$55
Standard Progressive**	$90	$40
Premium Progressive**	$90, 80% of Charge less $120 Allowance	$40

Lens Options:
UV Treatment	$15	N/A
Tint (Solid and Gradient)	$15	N/A
Standard Plastic Scratch Coating	$15	N/A
Standard Polycarbonate	$40	N/A
Standard Anti-Reflective Coating	$45	N/A
Other Add-Ons and Services	20% off Retail Price	N/A

Contact Lenses
(Contact lens allowance includes materials only)
Conventional	$0 Copay; $130 allowance, 15% off balance over $130	$110
Disposable	$0 Copay; $130 allowance, plus balance over $130	$110
Medically Necessary	$0 Copay, Paid-in-Full	$200

Frequency:
Examination	Once every 12 months
Frame	Once every 24 months
Lenses or Contact Lenses	Once every 12 months

Monthly Rate
Subscriber	$6.09
Subscriber + Family	$14.48


** Standard/Premium Progressive lenses not covered - fund as a Bifocal Lens

Additional Discounts:
Member receives a 20% discount on items not covered by the plan at network Providers, which cannot be combined with any other discounts or promotional offers. Discount does not apply to EyeMed Provider's professional services, or contact lenses.
Members also receive 15% off retail price or 5% off promotional price for Lasik or PRK from the US Laser Network, owned and operated by LCA Vision.
Members also receive a 40% discount off complete pair eyeglass purchases and a 15% discount off conventional contact lenses once the funded benefit has been used.
After initial purchase, replacement contact lenses may be obtained via the Internet at substantial savings and mailed directly to the member. Details are available at www.eyemedvisioncare.com.
Fidelity Security Life Policy number VC-19/VC-20, form number M-9059


Plan Exclusions:
1) Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; 2) Medical and/or surgical} treatment of the eye, eyes or supporting structures;
3) Any eye or Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; Safety eyewear
4) Services provided as a result of any Workers' Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof;
5) Plano (non-prescription) lenses and/or contact lenses; 6) Non-prescription sunglasses; 7) Two pair of glasses in lieu of bifocals;
8) Services or materials provided by any other group benefit plan providing vision care; 9) Certain brand name Vision Materials in which the manufacturer imposes a no-discount policy;
10) Services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the insured Person are within 31 days from the date of such order.
11) Lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available.