Vision Insurance Plan Year 2013 Optum Health Vision/Spectera

1. Vision InsurancePlan Year 2013Optum Health Vision/Spectera

2. Plan Design/Premium Changes for AE 2013 • Vision – Spectera • Branding name will change from OptumHealth to Spectera • Select Plus Plan will have the following enhancements: • Frequency of frames will change to once every 12 months • Frame allowance of $150 is provided for private practice or retail chain providers • Standard contact lenses will have a $200 allowance • Allow up to 8 boxes of standard, disposable lenses • Out-of-network allowance for contact lenses will increase to $200 under the Select Plus Plan

3. Plan Design/Premium Changes for AE 2013 • Vision – Spectera • New premium rate structure for the Select Plus Plan • You Only $8.62 • You + Spouse $18.61 • You + Child $19.45 • You + Family $26.35 Admin fee is included in amount

4. Vision • Coverage level available: • 4 Tier Structure • Employee, • Employee+Child, • Employee+Spouse, • Family • Pre-tax premiums • Network of eye care providers • Benefits available for in-network & out-of-network services

5. Vision • Frequency: • Routine Eye Exams: every 12 months • Lenses: every 12 months • Frames: every 24 months • Contacts: every 12 months

6. Vision Insurance Vision • $50 Wholesale allowance for Private Practice providers will be replaced with $130 Retail allowance • Participants will know how much they are required to spend • Participants will have more freedom of choice between Retail providers and Private Practice providers • Online ID cards will be provided for Participants • Participants log in to web site: www.myoptumhealthvision.com • ID cards can be printed for employee or family members • Log in with the employee’s identification number, enter the dependent’s last name and Date of Birth • No limit to the number of cards which can be printed

7. Vision Select Plan • Vision Insurance (Select Plan) operates the same way as the Current Plan • Frequency and co-pays are the same • In-network Benefits are the same • Out-of-Network Reimbursements are the same

8. Vision Select Plus Plan • Vision Insurance (Select Plus Plan) operates the same as the Select Plan with additional enhancements: • Higher maximum for contact lenses: $125 • Cosmetic lens options (i.e. Tints, UV coating, Basic Progressive, Polycarbonate) are covered • Glasses/frames/contacts co-pay for Select Plus Plan is $25

9. Benefits Chart * Only a one time $20 material copay applies per benefit period.

10. Benefits Chart * Only a one time $20 material copay applies per benefit period.

11. Benefits Chart * Only a one time $20 material copay applies per benefit period.

12. Medically Necessary contacts • OptumHealth Vision must establish that an eligible member has any of the following: • Keratoconus or irregular astigmatism • Anisometropia of 3.50 diopters or more • Post cataract surgery without intraocular lens • Visual acuity in the better eye of less than 20/70 with spectacles, but better than 20/70 with contacts

13. Benefits Chart

14. Reminders • If you use in-network providers, you are responsible only for your portion of cost. • If you decide to use a non-network provider, you pay everything and seek the out-of-network benefits payments schedule • Payment is made at the time of service • To be reimbursed for an non-network service, receipts must be submitted to OptumHealth • Receipts must be submitted together for services and materials purchased on different dates to receive reimbursement