B.C. Clark Standard Insurance Company Monthly Rates Employee Only (EE) $9.73 EE + Spouse $19.46 EE + Children $18.48 EE + Spouse & Children $29.04 Additional Balanced Care Vision I Choice Network Features Contact Lenses Elective Allowance can be applied to disposables, but the dollar amount must be used all at once (provider will order 3 or 6 month supply). Applies when contacts are chosen in lieu of glasses. For plans without a separate contact fitting & evaluation (which includes follow up contact lens exams), the cost of the fitting and evaluation is deducted from the allowance. Additional Glasses 20% off additional complete pairs of prescription glasses and/or prescription sunglasses.* Frame Discount VSP offers 20% off any amount above the retail allowance.* Laser VisionCare VSP offers an average discount of 15% off or 5% off a promotional offer for LASIK Custom LASIK and PRK. The maximum out-of-pocket per eye for participants is $1,800 for LASIK and $2,300 for custom LASIK using Wavefront technology, and $1,500 for PRK. In order to receive the benefit, a VSP provider must coordinate the procedure. Low Vision With prior authorization, 75% of approved amount (up to $1,000 is covered every two years). Based on applicable laws, reduced costs may vary by doctor location. Section 125 This plan is provided as part of the Policyholder's Section 125 Plan. Each employee has the option under the Section 125 Plan of participating or not participating in this plan. If an employee does not elect to participate when initially eligible, he/she may elect to participate at the Policyholder's next Annual Election Period. Vision Plan Participant Service Balanced Care Vision I from The Standard features the money-saving eye care network of VSP. Customer service is available to plan participants through VSP's well-trained and helpful service representatives. Call or go online to locate the nearest VSP network provider, view plan benefit information and more. VSP Call Center: 800.877.7195  Service representative hours: 5 a.m. to 7 p.m. Pacific Monday through Friday, 6 a.m. to 2:30 p.m. Pacific Saturday  Interactive Voice Response available 24/7 Locate a VSP provider at: www.standard.com/services