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Section 3 - Proposed Benefits I 1 <br />City of Sunny Isles <br />• <br />f � <br />Basic Vision - An option for EPO, POS, PPO and Indemnity <br />Scheduled Benefit <br />Network* Yes ' <br />Out -of- Network Services Yes <br />Copayment Does not apply <br />Funding Options Self - funded <br />Features A Flexibility in maximums, benefit periods <br />A No separate eligibility submission required <br />* Members can go out -of- network to visit any licensed provider (subject to plan exclusions and limitations), but using Vision One <br />location generally lowers member's out of pocket expense. <br />This material is for informational purposes only and is neither an offer of coverage nor medical advice. /t contains only a <br />partial, general description of plan or program benefits and does not constitute a contract. All the terms and conditions of your <br />plan or program are subject to applicable laws, regulations and policies. The availability of a plan or program may vary by <br />geographic service area. <br />Aetna U.S. Healthcare does not provide health care services, and therefore cannot guarantee any results or outcomes. <br />Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna <br />U.S. Healthcare or its affiliates. The availability of any particular provider cannot be guaranteed, and provider network <br />composition is subject to change without notice. <br />While this material is believed to be accurate as of the print date, it is subject to change without notice. In case of conflict <br />between your plan documents and this information, the plan documents will govern. <br />Visit our website: www.aetnaushc.com 11/17/2000 <br />