BENEFITS NOT COVERED BY THE VISION PLAN

IQVIA Benefits Handbook

No benefits will be paid for services or materials connected with or charges arising from:

Medical or surgical treatment, services or supplies for the treatment of the eye, eyes or supporting structures;

Refraction, when not provided as part of a Comprehensive Eye Examination;

Services provided as a result of any Workers' Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof;

Orthoptic or vision training,

Subnormal vision aids and any associated supplemental testing;

Aniseikonic lenses;

Any Vision Examination or any corrective Vision Materials required by a Policyholder as a condition of employment;

Safety eyewear;

Solutions, cleaning products or frame cases;

Non-prescription sunglasses;

Plano (non-prescription) lenses;

Plano (non-prescription) contact lenses;

Two pair of glasses in lieu of bifocals;

Electronic vision devices;

Services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the Insured Person are within 31 days from the date of such order;

Lost or broken lenses, frames, glasses, or contact lenses that are replaced before the next Benefit Frequency when Vision Materials would next become available.

Fees charged by a Provider for services other than a covered benefit and any local, state or Federal taxes must be paid in full by the Insured Person to the Provider. Such fees, taxes or materials are not covered under the Policy. Allowances provide no remaining balance for future use within the same Benefit Frequency. Some provisions, benefits, exclusions or limitations listed herein may vary by state.

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