A BrightVision Proposal For

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

BrightVision 1powered by Davis VisionBenefitDescriptionEye ExamFocuses on your eyes, vision and wellnessPrescriptionGlassesOptions belowPay no more than 25 for Exclusive Collection frames atparticipating locations or 130 frame allowance at network locations orFrameCopayFrequency 10Every 12 months--includedEvery 24 months 25Every 12 months 180 frame allowance at Visionworks1Plus 20% off any amount over your allowance2Clear plastic single-vision, bifocal, trifocal or lenticular lensesLenses andenhancements3Polycarbonate Lenses for dependent childrenTinting of Plastic LensesScratch-Resistant CoatingPolycarbonate lenses for adults 30High-Index Lenses 1.67 55High-Index Lenses 1.74 120Polarized LensesLensupgrades3 75Progressive Lenses (Standard / Premium / Ultra / Ultimate)Anti-Reflective (AR) Coating(Standard / Premium / Ultra / Ultimate)Ultraviolet Coating(instead of glasses) 35 / 48 / 60 / 85 12Plastic Photochromic Lenses (Transitions Signature ) 65Premium Scratch-Resistant Coating 30Scratch-Protection Plan (Single-Vision / Multifocal)Prescriptioncontacts4 50 / 90 / 140 / 175Every 12 months 20 / 40Digital Single Vision Lenses 30Trivex Lenses 50Blue Light Filtering 1515% off fitting, evaluation and follow-up 130 allowance for contacts-Every 12 monthsPlus 15% off any amount over your allowance2Extra 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 promotions5No more than 39 on routine retinal imaging as an enhancement to an eye exam.30% off additional pairs of eyeglasses2.Free 1-yr. breakage warranty on your glasses - limitations apply.Out-of-network coverageExamFrame 40 50Single vision lensesBifocal/Progressive lenses 40 60Trifocal lensesLenticular lenses 80 100Elective contactsVisually required contacts 105 2251. Excludes Maui Jim eyewear. 2. Some limitations apply to additional discounts; discounts not applicable at all in-network providers. 3. Spectacle lens options may not beavailable at all locations. 4. Contact lens coverage varies by product selection. Visually Required contacts are covered in full with prior approval. 5. Over 40% off pricing asreferenced in the Consumer Guide to Hearing Aids. Discount varies depending on product. This offer is only good at participating Your Hearing Network provider locations andcannot be combined with any other offer or discount. Davis Vision has done its best to accurately reflect plan coverage herein. If differences exist between this document andthe plan contract, the contract will prevail. Products in the state of New York are underwritten by Commercial Travelers Life Insurance Company. Policy form number CVIGRP2020. In all other states, they are underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with the Guardian LifeInsurance Company of America, a/k/a The Guardian or Guardian Life. Policy form number NVIGRP 2020 or NVIGRP-DV 2019. BV1SUM21

BrightVision 1 ratesMonthly PremiumsCoverageVoluntaryNon-VoluntaryEmployee 7.60 5.70Employee & spouse 15.24 11.38Employee & child(ren) 14.58 11.00Family 22.32 16.78Enrollment 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 otherstates, they are underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with the GuardianLife Insurance Company of America, a/k/a The Guardian or Guardian Life. Policy form number NVIGRP 2020 or NVIGRP-DV 2019. BV1PROPCAPBEN21

More features, discounts and benefitsUse your benefit to shop for eyewear online.Members can use their in-network benefits at glasses.com, 1800contacts.com and visionworks.com.What is the Exclusive Collection1?Instead of using the frame allowance, members can choose frames from Davis Vision’s Exclusive Collection, at no more than 25 out-of-pocket, depending on the benefit plan. Frames in the Collection retail at 100 - 195 and are available at mostparticipating independent provider locations.Plan-covered glasses come with a free one-year breakage warranty.All eyeglasses come with a breakage warranty for repair or replacement of the frame and/or lenses for a period of one yearfrom the date of delivery. The one-year breakage warranty applies to all plan-covered eyeglasses (i.e., all spectacle lenses,Exclusive Collection frames and national retailer frames, where the Exclusive Collection is not displayed).If a member needs more scratch protection Standard scratch-resistant coating is available on plastic lenses at no extra cost as part of the benefit. Members may alsopurchase an optional scratch protection plan, which will replace scratched lenses with new lenses of the same material, styleand prescription, at no charge for one year from the original date of dispensing.There are more lens options available.Edge polish 22High luster edge polish 70Roll & polish 16Roll edge 24Rimless drill 66Slab off 186Specialty lenses(Myodisc, Lenticulargrind, Double sided grind) 206Mirror (solid, single,& double gradient) 86Members get a discount on additional glasses or contacts2.Members will receive a 50% discount on additional complete pairs of eyeglasses and sunglasses at Visionworks and 30% offat other participating providers on the same transaction. Otherwise, a 20% discount off the provider’s usual and customaryrate is available. For contact lens transactions, members get a 10% discount on additional pairs.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 adiscounted2 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 allows for early detection, diagnosis, andongoing monitoring of diseases which can affect the eyes and overall health.What is “low vision,” and what is the benefit coverage?An eye care professional may determine a member has low vision if their impairment interferes with daily activities andcannot be corrected with standard eyewear, medicine or surgery. Members who require low vision services and opticaldevices are entitled to the following coverage, both in- and out-of-network, with prior approval from Davis Vision:BenefitDescriptionCharge/AllowanceLow vision evaluationOne comprehensive evaluation, sometimes called afunctional vision assessmentMax charge of 300Low vision aidItems such as high-power spectacles, magnifiers,and telescopesLow vision follow up careFour (4) office visitsMax allowance of 600(Lifetime max of 1,200)FrequencyEvery 5 yearsMax charge of 1001. Participating retail providers typically do not display the Collection, but are contractually required to maintain a comparable selection (in bothquantity and quality) of frames that would be covered, with no additional member out-of-pocket expense. Collection is subject to change. 2. Additionaldiscounts are not applicable at Costco, Sam’s Club, and Walmart locations, or where limited by law or manufacturer restrictions.Products in the state of New York are underwritten by Commercial Travelers Life Insurance Company. Policy form number CVIGRP 2020. In all otherstates, they are underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with the GuardianLife Insurance Company of America, a/k/a The Guardian or Guardian Life. Policy form number NVIGRP 2020 or NVIGRP-DV 2019. BV1PROPCAPBEN21

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 otherstates, they are underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with the GuardianLife Insurance Company of America, a/k/a The Guardian or Guardian Life. Policy form number NVIGRP 2020 or NVIGRP-DV 2019. BV1PROPCAPBEN21

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.

BrightBenefits Vision Product AvailabilityAvailableStateDavisVSPSuperiorNotes / Policy Form leAvailableAvailableAvailableNot AvailableNVIGRP 2020NVIGRP 2020-ALNVIGRP 2020AZCACOCTDCDEAvailableAvailableAvailableNot AvailableNot AvailableAvailableAvailableAvailableAvailableNot ableNot AvailableAvailableAvailableNVIGRP 2020NVIGRP 2020-CANVIGRP 2020-COFL-LGAvailableAvailableAvailableFL-SGNot AvailableNot AvailableNot eNot ot DMEMIMNMO-LGNot AvailableAvailableAvailableNot AvailableAvailableNot ableAvailableAvailableAvailableNot AvailableMO-SGMSMTNot AvailableAvailableAvailableNot AvailableAvailableNot AvailableNot ilableNVIGRP 2020-DCNVIGRP-DV 2019NVIGRP 11/13NVIGRP-SV 2019 50 eligible employeesNVIGRP 2020-FLLG 50 eligible employeesNVIGRP 2020-GANVIGRP 2020-HINVIGRP 2020-IANVIGRP 2020-IDNVIGRP 2020-ILNVIGRP 2020NVIGRP 2020-KSNVIGRP 2020-KYNVIGRP 2020-LANVIGRP-DV 2019-MANVIGRP-SV 2019-MANVIGRP-SV 2019-MDNVIGRP 2020-MENVIGRP 2020-MILGNVIGRP 2020-MN 50 eligible employeesNVIGRP 2020 50 eligible employeesNVIGRP 2020-MSNVIGRP-DV 2019-MTNVIGRP-SV 2019-MTNVIGRP 2020-NCProducts in the state of New York are underwritten by Commercial Travelers Life Insurance Company. Policy form number CVIGRP 2020. In all otherstates, they are underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with the GuardianLife Insurance Company of America, a/k/a The Guardian or Guardian Life. Policy form number NVIGRP 2020 or NVIGRP-DV 2019. BV1PROPCAPBEN21

NDAvailableAvailableAvailableNVIGRP 2020-NDNENHAvailableAvailableAvailableNot AvailableAvailableAvailableNJNMNVNY-LGNot AvailableAvailableAvailableAvailableNot AvailableNot AvailableAvailableAvailableNot AvailableNot AvailableAvailableAvailableNVIGRP 2020-NENVIGRP-DV 2019-NHNVIGRP-SV 2019-NHNY-SGNot AvailableNot AvailableNot ableNot AvailableNot ableAvailableAvailableNot AvailableNot ableAvailableAvailableNot AvailableNot AvailableNot vailableNorthern VArestricted by zipzode*AvailableNot ableAvailableAvailableAvailableNot AvailableAvailableAvailableAvailableAvailableNot RP-DV 2019-NMNVIGRP 2020-NV 50 eligible employeesCVIGRP 2020-NY 50 eligible employeesNVIGRP 2020-OHNVIGRP 2020-OKNVIGRP 2020-ORNVIGRP 2020-SCNVIGRP 2020NVIGRP 2020NVIGRP-DV 2019-TXNVIGRP 11/13 TX(R)NVIGRP-SV 2019-TXNVIGRP 2020-UTNVIGRP 2020-VANVIGRP 2020-VTNVIGRP 2020NVIGRP 2020NVIGRP 2020-WY*Northern Virginia zip codes restricted for Davis Vision.FairfaxCountyZip CentrevilleCliftonZip Code22102221032210622107CityMc LeanWest McleanMc LeanMc LeanProducts in the state of New York are underwritten by Commercial Travelers Life Insurance Company. Policy form number CVIGRP 2020. In all otherstates, they are underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with the GuardianLife Insurance Company of America, a/k/a The Guardian or Guardian Life. Policy form number NVIGRP 2020 or NVIGRP-DV 2019. BV1PROPCAPBEN21

RestonAnnandaleBurkeBurkeDunn irfaxFairfax StationFalls ChurchFalls ChurchFalls ChurchFalls ChurchFort BelvoirGreat onMc 231222315Mc LeanMc LeanMerrifieldMerrifieldMerrifieldMount andriaAlexandriaAlexandriaAlexandriaProducts in the state of New York are underwritten by Commercial Travelers Life Insurance Company. Policy form number CVIGRP 2020. In all otherstates, they are underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with the GuardianLife Insurance Company of America, a/k/a The Guardian or Guardian Life. Policy form number NVIGRP 2020 or NVIGRP-DV 2019. BV1PROPCAPBEN21

A BrightVision proposal for Effective 100 Winners Circle, Ste. 220 Brentwood, TN 37027 Proposal presented by Capital Benefits Proposal date: This proposal is valid for 90 days.

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