Certificate of Coverage

Client Vision Care Plan EVIDENCE OF COVERAGE REVISED Provided by: VISION SERVICE PLAN INSURANCE COMPANY 3333 Quality Drive, Rancho Cordova, CA 95670 (916) 851-5000 (800) 877-7195 Client Name: BALL STATE UNIVERSITY Client Number: 30011190 Effective Date: JANUARY 1, 2025 Notice to Client: In the event this document is used to develop a Summary Plan Description, complete the information below, as applicable. EOC IN 1114