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Section 3 - Proposed Benefits 10 • City of Sunny Isles Vision Prescription A low -cost benefit for eyewear available as an option for HMO, QPOS® Eyewear Rider and USAccess® Network* Yes Out -of- Network Services Yes Claim Forms Only if out -of- network i Funding Options Full -risk prospectively rated Features A Generally decreases member out -of- pocket expense A Included in every health plan, excluding Family Care and New Jersey MdCare * Members can go out -of- network to visit any licensed provider (subject to plan exclusions and limitations), but using Vision One location generally lowers member's out of pocket expense. This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a • partial, general description of plan or program benefits and does not constitute a contract. All the terms and conditions of your plan or program are subject to applicable laws, regulations and policies. The availability of a plan or program may vary by geographic service area. Aetna U.S. Healthcare does not provide health care services, and therefore cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna U.S. Healthcare or its affiliates. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change without notice. While this material is believed to be accurate as of the print date, it is subject to change without notice. In case of conflict between your plan documents and this information, the plan documents will govern. Visit our website: www.iietnaushc.com 11/17/2000