CONTACTS 1 IN LIEU OF GLASSES. Allowance: CONVENTIONAL 2 $150. +ADDITIONAL 15% OFF any overage. 3. Evaluation, fitting & follow-up care:

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1 DAVISVISION.COM 1 (877) TRANSPORT WORKERS UNION YOUR VISION PLAN FREQUENCY Exam: September 1 Lenses & Lens Upgrades: September 1 Frame: September 1 Contacts, Eval. & Fitting: September 1 SIGN UP DURING ANNUAL ENROLLMENT For more details about the plan, just log on to the Open Enrollment section of our Member site at davisvision.com/member or call 1 (877) and enter Client Code EXAM LENSES CONTACTS 1 IN LIEU OF GLASSES YOUR MEMBER ACCOUNT Eye Exam copay: $20 Lens copay: $20 FRAME Allowance: CONVENTIONAL 2 $150 +ADDITIONAL 15% OFF any overage. 3 Evaluation, fitting & follow-up care: Log in using your client code at davisvision.com/member to find a list of in-network providers near you and access your benefit information. Allowance: VISIONWORKS OTHER LOCATIONS $130 Covered in Full +ADDITIONAL 20% OFF any overage. 3 OR The Exclusive Collection copay: FASHION DESIGNER PREMIER Covered Covered $25 CONVENTIONAL LENS OR The Exclusive Collection of Contact Lenses: 4 Covered SPECIALTY LENS 15% Discount 15% Discount THE EXCLUSIVE COLLECTION The Exclusive Collection of frames is available at close to 9,000 locations across the U.S. Log in to your account to browse frames and find a Collection near you. FIND A NETWORK PROVIDER... Just log on to the Open Enrollment section of our Member site at davisvision.com/member and click Find a Provider to locate a provider near you including: FREE BREAKAGE WARRANTY Your glasses are covered with our FREE one-year breakage warranty Some limitations apply. OE01256_7/24/ Contact lens coverage varies by product selection. 2. Visually Required contacts are covered-in-full with prior approval. 3. Some limitations apply to additional discounts, discounts not applicable at all in-network providers. 4. The Exclusive Collection of Contact Lenses evaluation, fitting and follow-up care is covered-in-full. Davis Vision has done its best to accurately reflect plan coverage herein. If differences exist between this document and the plan contract, the contract will prevail.

2 COPAYS FOR OPTIONS & UPGRADES LENS OPTIONS Clear plastic single-vision, bifocal, trifocal or lenticular lenses (any RX)... $0 Oversized Lenses... $0 Plastic Lenses... $0 Polycarbonate Lenses (Children / Adults)... $0 or $30 High-Index Lenses... $55 Polarized Lenses... $75 Progressive Lenses (Standard / Premium / Ultra)... $50 / $90 / $140 Anti-Reflective (AR) Coating (Standard / Premium / Ultra)... $35 / $48 / $60 Ultraviolet Coating... $12 Tinting of Plastic Lenses (Solid / Gradient)... $0 Plastic Photochromic Lenses (Transitions Signature )... $65 Scratch-Resistant Coating... $0 Scratch-Protection Plan (Single-Vision Multifocal)... $20 $40 ADDITIONAL SAVINGS Retinal Imaging (Member Charge)... $39 Additional Pairs of Eyeglasses... 30% discount 3 OUT-OF-NETWORK BENEFITS You may receive services from an out-of-network provider, although you will receive the greatest value and maximize your benefit dollars if you select a provider who participates in the network. If you choose an out-of-network provider, you must pay the provider directly for all charges and then submit a claim for reimbursement to: Vision Care Processing Unit P.O. Box 1525 Latham, NY OUT-OF-NETWORK REIMBURSEMENT SCHEDULE (UP TO) Eye Examination: $40 Frame: $50 Single-Vision Lenses: $40 Bifocal / Progressive Lenses: $60 Trifocal Lenses: $80 Lenticular Lenses: $100 Elective Contact Lenses: $105 Visually Required Contacts: $225

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4 PREMIUM COLLECTION CONTACT LENS COLLECTION * TYPE FREQUENCY BRAND MANUFACTURER PLANNED REPLACEMENT Includes 2 or 4 boxes, Depending upon plan design (Provides up to 6 or 12 month supply, depending upon the provider-recommended wearing schedule) Planned Replacement Planned Replacement Biofinity Frequency Aspheric CooperVision CooperVision DISPOSABLE Includes 2, 4 or 8 boxes, Depending upon plan design (Provides up to 6 or 12 month supply, depending upon the provider-recommended wearing schedule) 2 Week ACUVUE 2 Vistakon 2 Week ACUVUE OASYS Vistakon Daily ClearSight TM 1-Day CooperVision Daily 1-Day ACUVUE MOIST Vistakon Toric (2 Week) ACUVUE OASYS for ASTIGMATISM Vistakon Toric (2 Week) Biomedics Toric CooperVision Medical (2 Week) ACUVUE OASYS for PRESBYOPIA Vistakon *The contact lenses listed here are part of the Davis Vision formulary of products, which is subject to change. HOW TO FIND OUR CONTACT LENS COLLECTION: These contact lenses can be ordered by vision care providers. To maximize Davis Vision plan value, ask your eye care professional if the Contact Lens Exclusive Collection of contact lenses listed above is right for your vision care needs. Follow us online #DAVISVISION 1 (800) DAVISVISIONCONTACTS.COM CLENSC PREMIUM

5 OUR EXCLUSIVE COLLECTION The Davis Vision Exclusive Collection consists of 222 frames showcased on a compact rotating fixture. The Exclusive Collection displays top-selling eyewear offered to our members for low-to-no out-of-pocket cost. ONE-YEAR EYEGLASS BREAKAGE WARRANTY INCLUDED Bongo Caterpillar Candies Cosmopolitan Dereon Converse Gant Stetson Elizabeth Arden Chelsea Morgan Harley-Davidson Jill Stuart Jones New York Perry Ellis Robert Mitchel Gloria Vanderbilt Nascar New Balance Seventeen Skechers Steve Madden Tapout Rampage Cover Girl South Hampton Catherine Deneuve 1 (800) l Davis Vision does not assert or claim ownership or exclusive use in any third party logos or registered trademarks; said third party logos or registered trademarks remain property of their respective holders. *Available brands may vary according to provider selection.