About The Vision Plan

If you enroll in one of the HMSA or CIGNA Medical Plans, you are eligible to receive vision benefits through Vision Service Plan (VSP). These benefits are described in the sections below. If you enroll in Kaiser, you are eligible to receive vision benefits through Kaiser (for details on these benefits, refer to your Kaiser booklet).*

The Vision Plan provides covered individuals with comprehensive vision care coverage. You may receive vision care services through either VSP or non-VSP providers. When you do use a VSP provider, you will receive greater benefits than if you use a non-VSP provider. The sections below provide more details.

To find a VSP provider, you can call VSP at 800-877-7195, or you can access a provider listing via the VSP Website at www.vsp.com. The Website can also confirm your eligibility for benefits under A&B's Plan.

With 18,000 VSP providers nationwide practicing in more than 24,000 locations, most employees should be able to find a VSP provider that meets their needs—and receive the increased benefits the Plan provides when you do use VSP providers. Of course, you may use any qualified vision provider and still receive benefits.

When You Visit A VSP Provider

Each time you visit a VSP provider, you pay the following charges...

• $10 for a comprehensive examination

• $25 for materials (i.e., spectacle lenses and/or frames)

• Any charges for cosmetic extras (such as tinted or oversize lenses, and charges for frames above the allotted frame allowance)

There are no claim forms to file—VSP pays all remaining charges according to the frequency guidelines outlined under What The Vision Plan Covers. Contact lenses are also available as described in that section.

When You Visit A Non-VSP Provider

VSP also covers services you receive from non-VSP providers. When you visit a non-VSP provider within the frequency limitations that apply to the service, you will be reimbursed according to a schedule of allowances. (See What The Vision Plan Covers). If the scheduled benefit is not enough to cover the entire cost of the services, you pay the remaining charges.

Under the Vision Plan, you and your eligible dependents may each receive—within the frequency guidelines outlined in the table below—the following...

• A comprehensive vision examination, including a refraction test to determine the need for glasses, binocularity analysis, and testing the overall health of the eyes and related optic structures.

• Additional testing for glaucoma and depth perception.

• Necessary prescription lenses and eyeglass frames (within allowable limits). In addition to standard lenses, the Vision Plan also covers polycarbonate lenses, which are extremely durable, scratch-resistant, and lightweight.

• Contact lenses in lieu of lenses and frames. For example, if you obtain elective contact lenses, you will not be eligible for a new frame for 24 months.*

Benefits For Severe Vision Problems

If you have severe vision problems, as diagnosed by your doctor, the Plan provides "low vision benefits." Upon prior authorization by VSP, these benefits include supplemental testing and optical aides. For more information, contact VSP at 800-877-7195.

VSP Member Discounts

The VSP Plan features two standard discounts when you visit a VSP provider...

• Additional pairs of prescription eyeglasses (that is, lenses and frames purchased separate from the Plan's regular benefits) are available at a 20% discount from the VSP provider's usual and customary retail charges.

• A 15% discount on professional services is available from VSP providers when contact lenses are purchased. The discount is also valid when the contact lens services are in addition to the dispensing of glasses.

These discounts are good for 12 months following the initial covered exam, and must be obtained from the same VSP provider who provided your last covered eye exam.

VSP members also have access to VSP's Laser VisionCareSM Program, including comprehensive information on laser correction and discounted fees from participating surgery centers. For more information, ask your participating eyecare provider, access the VSP website at www.vsp.com or call VSP at 888-354-4434.

Under the Vision Plan, you may receive services from any legally qualified optometrist or ophthalmologist; however, the Plan pays increased benefits when you receive services from a "VSP" provider as outlined previously.

There are no claim forms to file when you obtain services from a VSP provider. However, if you receive vision services from a non-VSP provider, you must submit to VSP an itemized statement along with your bill to receive benefits.

To obtain benefits under VSP, follow these steps...

1. Obtain a list of VSP member providers. You can do this by calling VSP at 800-877-7195, or accessing VSP's Web site at www.vsp.com. If you already have a vision provider, check the listing (or call your provider) to see whether he or she is a VSP provider.

2. Call a provider and make an appointment. If you are calling a VSP provider, be sure to give the provider's office your Social Security Number and tell the office that you are a VSP participant. The VSP provider will call VSP to verify your (or your dependent's) eligibility and plan coverage. If you are not eligible—for example, if you have already had an exam within the allotted time frame—the provider's office will explain to you why, and discuss your options.

3. Then, if you receive services from a:

   • VSP provider, simply pay the applicable copayment(s) at the time of your visit. The provider will bill VSP directly and no further paperwork will be required. (The provider will also itemize any optional charges that are your responsibility. For information about any additional charges you may be required to pay, see What The Vision Plan Does Not Cover .)

   • Non-VSP provider, you must pay the bill in full at the time you receive the services. Then, submit an itemized statement to VSP. VSP will then reimburse you according to the schedule of allowance for non-VSP providers outlined in the table under What the Plan Covers. Be sure to submit this information to VSP within six months of your visit. Claims should be sent to...

     Vision Service Plan

     Attention: Out-of-Network Provider Claims

     P.O. Box 997100

     Sacramento, CA 95899-7100

When submitting your claim, be sure to include the following:

• An itemized receipt listing the services received.

• The name, address and phone number of the provider.

• Your name, address, phone number, and Social Security Number (or member Identification Number).

• The name of the group (i.e., Alexander and Baldwin).

• If services were provided to a dependent, the patient's name and relationship to you (i.e. spouse/domestic partner, child), date of birth, phone number, and address.

This Plan is designed to cover your visual needs rather than cosmetic materials. Therefore, there will be an extra charge for any of the following (discounts may apply through VSP providers as noted under VSP Member Discounts )...

• Blended, cosmetic, coated, laminated, oversize, photochromic, progressive multifocal, tinted (other than Pink 1 or 2), or UV-protected lenses

• A frame that costs more than the Plan allowance

• Optional cosmetic processes

In addition, this Plan does not cover the following services or materials...

• Orthoptics or vision training, and any associated supplemental testing

• Non-prescription plano lenses

• Two pairs of glasses in lieu of bifocals

• Replacement of lost or broken lenses and frames furnished under this program except at the normal intervals when services are otherwise available

• Medical or surgical treatment of the eyes (such services may be covered under your medical plan)

• Any eye examination, or corrective eye wear required by an employer as a condition of employment

• Corrective vision services, treatments and materials of an experimental nature