DEFINITIONS Allowance means the benefit amount shown in the Schedule of Benefits that is the maximum amount payable by the Company, subject to the expenses incurred. The Insured Person is responsible for any amounts due above the Allowance. The Allowance cannot be used to satisfy a Copayment. Benefit Frequency means the period of time in which a benefit is payable as shown in the Schedule of Benefits. The Benefit Frequency begins on September 1. Each new Benefit Frequency begins at the expiration of the previous Benefit Frequency. Copayment or Copay means the designated amount, if any, shown in the Schedule of Benefits each Insured Person must pay to a Provider before benefits are payable for a covered Vision Examination or Vision Materials per Benefit Frequency. Comprehensive Eye Examination means a general evaluation of the complete visual system. The examination includes history, general medical observation, external and ophthalmoscopic examinations, gross visual fields, basic sensorimotor examination and Refraction. It always includes initiation of diagnostic and treatment programs. It may include biomicroscopy, examination with cycloplegia or mydriasis and tonometry, as determined by the Provider. These services may be performed at different sessions, but comprise only one Comprehensive Eye Examination. Dependent means any of the following persons whose coverage under the Policy is in force and has not ended: 1. the Insured’s lawful spouse; 2. each child of the Insured or the Insured’s spouse who is under 26 years of age; or 3. each child at least 26 years of age who is primarily dependent upon the Insured or the Insured’s spouse for support and maintenance because the child is incapable of self-sustaining employment by reason of mental incapacity or physical handicap. Dependent includes a step-child, foster child, legally adopted child, child for whom the Insured is a party to a suit for adoption, child who has been placed in the Insured’s home for adoption and child under the Insured’s legal guardianship. Dependent will also include a child for whom the Insured is legally required to support due to court order or divorce decree. Formulary means a list, provided by the Company, of Vision Materials by tier, that are covered under the Policy as shown in the Schedule of Benefits. Insured means an employee of the Policyholder who meets the eligibility requirements as shown in the Policyholder’s application, and whose coverage under the Policy is in force and has not ended. Insured Person means the Insured. Insured Person will also include the Insured’s Dependents, if enrolled. In-Network Provider means a Provider who has signed a Preferred Provider Agreement with the PPO. Medically Necessary Contact Lenses means that adequate functional vision correction cannot be achieved with spectacles but can be achieved with contact lenses. Conditions that qualify for Medically Necessary Contact Lenses are: 1. Anisometropia of 3D in meridian powers; 2. High Ametropia exceeding -12D or +12D in meridian powers; 3. Keratoconus when vision is not correctable to 20/25 in either eye or both eyes using standard spectacle lenses; or 4. vision impairments, other than Keratoconus, when vision can be improved by two lines on the visual acuity chart when compared to best corrected standard spectacle lenses. Out-of-Network Provider means a Provider, located within the PPO Service Area, but is not an In-Network Provider. Policy means the Vision Insurance Policy issued to the Policyholder. C-9184IN 3