| 18 | Vision Insurance, continued Preferred Pricing Options, continued Level 1 Progressives Covered in full Up to $40 Level 2 Progressives Covered in full Up to $48 All Other Progressives $140 allowance + up to 20% discount Up to $48 Transitions® (Single Vision/ Multi-Focal) $70/$80 n/a Polarized $75 PGX/PBX $40 Other Lens Options Up to 20% discount* Contact Lenses (In lieu of frame and spectacle lenses) Elective $175 allowance Up to $160 Medically Necessary** Covered in full Up to $250 Refractive Laser Surgery Up to 25% provider discount ¥ Onetime/lifetime $150 allowance Provider discount up to 25%* Onetime/lifetime $150 Frequency Eye Examination Once every 12 months Lenses or contact lenses Once every 12 months Glasses Frames Once every 24 months Vision Premium Cost Employee Only Employee + Child(ren) Employee + Spouse/DP Family Full & Part Time Rates $3.29 $7.16 $6.32 $9.38