Vision Care Benefit Comparison

VISION CARE BENEFITS Summary/Comparison

Anthem HEALTH Insurance Anthem Vision Delta Dental Vision VDT Reimbursement * (Point of Service Plan) (supplemental vision plan) Discount Program (for employee only) Eye 100% after $0 co-payment 100% after $15 co-payment Vision Discount Program Executive Branch (except AFSCME): 100% – annually Examination Ages 0-18 – Annual using a Network Provider available for Delta Dental (includes reimbursement for co-pay) (Routine) Ages 19-64 – Biennial every 24 months Members (see Ages 65 and over – Annual www.nedelta.com for details) Frames No Coverage Any frame up to $150 retail Vision Discount Program Executive Branch: see Lenses below value using a Network available for Delta Dental Judicial Branch: no coverage Discounts available-see Provider every 24 months Members (see State of Maine page at www.nedelta.com for www.anthem.com “Special details) Offers” for details. Lenses – No Coverage 100% after $15 co-payment Vision Discount Program Executive Branch: Professional & Technical Services; single vision using a Network Provider available for Delta Dental Operations, Maintenance & Support Services; Maine State Law (pair) every 24 months Members (see Enforcement & Maine State Troopers – regular corrective www.nedelta.com for lenses or glasses as prescribed by doctor- up to $75. No Coverage Same as above details) Administrative Services, Supervisory Services & Confidentials: up to $100, (glasses include frames and lenses) - annually Lenses – bifocal & No Coverage Progressives are covered up Executive Branch: Professional & Technical Services; trifocal to bifocal amount after $15 co- Operations, Maintenance & Support Services; Maine State Law Discounts available-see payment using a Network Enforcement & Maine State Troopers – for bifocal, trifocal and State of Maine page at Provider (available at progressive lenses or glasses as prescribed by doctor - up to Lenses – www.anthem.com “Special preferred pricing) every 24 $125. Administrative Services, Supervisory Services & progressives Offers” for details. months Confidentials - up to $150 (glasses include frames and lenses) - annually

Judicial Branch: up to $150 (lenses only) Contacts No Coverage – Except if Elective - $130 allowance Executive Branch: Professional & Technical Services; medically necessary – Post (Contact lenses are in lieu of Operations, Maintenance & Support Services; Maine State Law cataract surgery (natural frame & lenses) every 24 Enforcement & Maine State Troopers – regular corrective lenses not replaced) months contact lenses - up to $75; Bifocal, trifocal or progressive Non-Elective – 100% after contact lenses – up to $125; Administrative Services, $15 co-payment Supervisory Services & Confidentials - regular corrective lenses – up to $100; Bifocal, trifocal or progressive contact lenses, as prescribed by doctor – up to $150 - annually

Judicial Branch: up to $150 Safety No Coverage 20% discount available using Up to $75 Prescription Eyewear (MDOT, DOC) – annually Eyewear a Network Provider VDT Requirement – 80% of time spent operating VDTs for Executive Branch except AFSCME. 20 hours for Judicial Branch. *Please refer to member materials for details regarding vision coverage. **VDT reimbursement is subject to interpretation. Please contact Employee Relations if you need clarification. Legislative Branch is not included in this comparison.

Revised 08/16/2011