A BrightVision Essential Proposal For

BrightBenefits100 Winners Circle, Ste. 220Brentwood, TN 37027A BrightVision Essential proposal forEffectiveProposal presented byCapital BenefitsProposal date:April 21, 2021This proposal is valid for 90 days.

BrightVision Essential 5powered by VSP Vision CareBenefitDescriptionCopayFrequencyWellVision Exam Focuses on your eyes, vision and wellness 10Every 12 monthsPrescription GlassesOptions below 10Options belowincludedEvery 12 monthsincludedEvery 12 months 150 frame allowance or 170 frame allowance for featured brands1 orFrame 80 frame allowance at Walmart /Sam’s Club/Costco Plus 20% off any amount over your allowance2Single vision, lined bifocal, lined trifocal, lenticular orstandard progressive lensesLensesPolycarbonate lenses for dependent childrenLens EnhancementsPremium progressive lenses 95 - 105Custom progressive lenses 150 - 175Every 12 monthsAverage savings of 20-25%2 on other lens enhancementsPrescription contacts3Fitting and evaluationup to 60(instead of glasses) 150 allowance for contacts (copay does not apply)Diabetic EyecarePlus ProgramSMRetinal screening for members with diabetes. Additionalexams and services for members with diabetic eyedisease, glaucoma, or age-related macular degeneration.Limitations and coordination with your medical coveragemay apply. Ask your eye doctor for details. 20 per examEvery 12 monthsAs neededExtra member savings (not insured benefits)Complimentary Everplans subscription (worth 75/yr.) to organize life’s most important details, so they’re safe and easy to get toin an emergency.15% off standard laser vision correction or 5% off promotional prices at LasikPlus locations nationwide.Save over 40% on premium hearing aids through Your Hearing Network, plus other offers and promotions520% savings on additional glasses and sunglasses, including lens enhancements, from any network provider within 12 mo. ofyour last WellVision Exam.No more than 39 on routine retinal screening as an enhancement to a WellVision Exam.Extra 20 to spend on featured frame brands. Go to vsp.com/offers for details.Out-of-network coverageExamup to 45Single vision lensesup to 30Lined bifocal lensesup to 50Progressive lensesup to 50Frameup to 70Lined trifocal lensesup to 65Lenticular lensesup to 85Contactsup to 1051. Frame brands and promotions are subject to change. 2. Savings based on doctor’s retail price and vary by plan and purchase selection; average savings determined after benefitsare applied. Ask your VSP network doctor for more details. Coverage with a retail chain may be different or not apply. 3. 25 copay applies to visually required contacts and are coveredin full in-network and up to 210 out-of-network. Visually required contacts are a plan benefit when specific benefit criteria are satisfied and when prescribed by covered person'snetwork provider. VSP guarantees coverage from VSP network providers only. VSP and WellVision Exam are registered trademarks, VSP Diabetic Eyecare Plus Program is aservicemark of Vision Service Plan. Products may vary by state. Products in the state of New York are underwritten by Commercial Travelers Life Insurance Company. Policy formnumber CVIGRP 2020. In all other states, they are underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with theGuardian Life Insurance Company of America, a/k/a The Guardian or Guardian Life. Policy form number NVIGRP 2020 or NVIGRP 11/13. BVESS5SUM21

BrightVision Essential 4 ratesMonthly PremiumsCoverageVoluntaryNon-VoluntaryEmployee 13.04 9.74Employee & spouse 26.12 19.48Employee & child(ren) 24.86 18.68Family 38.10 28.58Enrollment assumptionsTotal number of benefit eligible employeesTotal number of enrolled employeesMinimum Participation Requirements Voluntary – The participation requirement is the greater of 3 enrolled employees or 50% or less of theeligible population. Non-Voluntary – The participation requirement is the greater of 3 enrolled employees or 50% of theeligible population. Groups with less than 10 eligible employees must use Voluntary rates regardless of participation andemployer contribution.Contract SitusRate Guarantee24 MonthsProducts in the state of New York are underwritten by Commercial Travelers Life Insurance Company. Policy form number CVIGRP 2020. In all other states, they areunderwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with the Guardian Life Insurance Company of America,a/k/a The Guardian or Guardian Life. Policy form number NVIGRP 2020 or NVIGRP 11/13. BVESS5PROPCAPBEN21

More features, discounts and benefitsUse your benefit to shop for eyewear online.Members can use their in-network benefits at eyeconic.com and visionworks.com.Members get a discount on additional glasses or contacts.Members will receive a 20% discount on additional complete pairs of eyeglasses and sunglasses at any network provider within12 months of their last WellVision Exam .What is “retinal imaging,” and is it covered?Retinal imaging is not a covered benefit, but members can receive a retinal imaging exam at participating providers at adiscounted fee. The exam enables the retina, macula, blood vessels, and optic nerve to be seen in wide angle, digital imageswithout the use of dilation drops. The exam is brief and very comfortable and helps detect early warning signs of commondiseases, such as glaucoma, diabetes, macular degeneration, hypertension, and even tumors.What is the “Diabetic Eyecare Plus Program”?This plan allows members to receive additional follow-up medical eye care services from network doctors. Members withdiabetes who do not have diabetic eye disease receive a covered-in-full retinal screening (digital imaging of the inside of theeye). These retinal photographs help your doctor establish a baseline to monitor and track changes in your eyes over time. If amember does have diabetic eye disease, glaucoma, or age-related macular degeneration, they can also receive additionalservices that track and monitor diabetic eye disease progression, follow-up medical eye exams deemed necessary by theirnetwork doctor, an additional eye exam with refraction for changes in vision due to diabetes medication(s).Products in the state of New York are underwritten by Commercial Travelers Life Insurance Company. Policy form number CVIGRP 2020. In all other states, they areunderwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with the Guardian Life Insurance Company of America,a/k/a The Guardian or Guardian Life. Policy form number NVIGRP 2020 or NVIGRP 11/13. BVESS5PROPCAPBEN21

Limitations and exclusionsLimitationsThe Contact Lenses benefit is paid in lieu of Eyeglass Lenses and Frames. An Insured is eligible to receive benefits under theEyeglass Lenses Benefit and the Frame benefit only after the Contact Lenses benefit Frequency has ended.The Eyeglass Lenses benefit and the Eyeglass Frame benefit is paid in lieu of the Contact Lenses benefit. An Insured iseligible to receive benefits under the Contact Lenses and the Eyeglass Frame benefit only after the Eyeglass Lenses benefitFrequency has ended.A Re-Enrollee who terminates coverage voluntarily or involuntarily and then subsequently re-enrolls for coverage under thisplan within a 12-month period may be subject to limited benefits corresponding with the Plan frequency.Coverage for a Late Entrant or Re-Enrollee is limited to the Vision Exam benefit during the first 12 months after such person’seffective date of coverage.Dilation is covered in full under the Vision Exam benefit ONLY if done for one of the following conditions: central vision loss,photopsia, floaters, high myopia, diabetes or history of ocular surgery, ocular trauma or ocular disease.This Plan is designed to cover “standard” or “basic” eyeglass lenses and frames. Add-on charges for specialty lenses and lensapplications are not covered. These extra charges are paid directly to the provider by the Member. Some items requiringadditional charges are listed below under Exclusions.ExclusionsNo benefits are payable for the any of the following conditions, procedures and/or materials, unless otherwise specificallylisted as a covered benefit in the Schedule of orrective Eyeglass Lenses, Frames, Contact Lenses, and related materials; and services for the fitting thereof;Replacement frames and/or lenses, (Including Low Vision Devices) except at normal intervals when covered servicesare otherwise available;Plano or non-prescription lenses or sunglasses;Orthoptics, vision training and any associated supplemental testing;Frame cases;Low (subnormal) vision aids or aniseikonic lenses;Medical and surgical treatment of the eyes;Charges incurred after (a) the Policy ends; or (b) the Insured’s coverage under the Policy ends, except as stated in thePolicy;Experimental or non-conventional treatment or device;Any eye examination or corrective eyewear required by an Employer as a condition of employment;Services and materials provided by another vision plan;Services for which benefits are paid by Worker’s Compensation;Benefits provided under the Insured’s medical insurance;Blended bifocal lenses;Groove, Drill or Notch, and Roll and Polish;Two pairs of glasses, in lieu of bifocals, trifocals or progressives;Coating on lenses (Factory scratch coat, anti-reflective, sunglass colors, etc.);Cosmetic items;Faceted lenses;High-Index Lenses;Laminated Lenses;Oversize Lenses – any lens with an eye size of 61mm or greater;Photochromic (Transition) lenses;Polarized lenses;Polished bevel lenses;Polycarbonate lenses;Prism lenses;Slab-off lenses;Tints (except Pink tint #1 and #2;Ultra-violet tint or coating;Additional cost for contact lenses over the allowance;Additional cost for a frame over the allowance;Progressive Lenses.Products in the state of New York are underwritten by Commercial Travelers Life Insurance Company. Policy form number CVIGRP 2020. In all other states, they areunderwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with the Guardian Life Insurance Company of America,a/k/a The Guardian or Guardian Life. Policy form number NVIGRP 2020 or NVIGRP 11/13. BVESS5PROPCAPBEN21

Life,Organized.Complimentary subscription1Organize and securely store life’s most importantinformation, so it is safe and easy to get to in an emergency.From personal finances and insurance policies, topasswords and family recipes, an Everplans subscriptionhelps organize your life’s details, for yourself and thepeople you love most.Every BrightBenefitsmember receives anEverplans subscriptionwith their dental and/orvision plan.2 With an Everplans subscription, BrightBenefits members get:SECURE STORAGEGUIDANCEData is encrypted and protectedusing industry leading privacy andsecurity technology. Everplans isHIPAA and SOC2 compliant, somember information is as privateas their medical records and assecure as their financial data.A step-by-step interface to helpguide users through organizingvital information and documents.Plus, members can accessthousands of articles, checklists,and guides.1. Retail value of 75/year, March 2021 2. This is not an insured benefit.SHARINGMembers have the ability to safelyshare their plan with select “Deputies”- family members, loves ones, trustedadvisors, etc. who will need access.Members designate which Deputieshave access to what information,and when.