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1 what s new online... Explore the exciting new features that make it easier for you to find information and make changes to your CompBenefits vision plan. Change Personal Information: You can now access and change personal demographic information, such as your name and address, directly from your CompBenefits account. Search for a Provider: By registering at MyCompBenefits.com, you can easily search for a Provider in your area that accepts your specific plan. ID Card: You may print temporary ID Cards and request permanent ID Cards online. Check the Status of a Claim: It s easy to check your claim status. Simply select the family member who received services and enter the time period to obtain a list of claims. From the list, click on the View option to see details on how the claim was paid. Ask Questions about a Claim: We re here to answer any questions you may have. From the claims detail screen, click Claims Question. You ll receive a response within one business day. How to Register Online: It s fast and simple! Step #1: Go to Step #2: Select Click here to Register Now! Step #3: Type the requested information on the PIN Registration page and click Next. Step #4: In the next page, enter your Member ID number. Step #5: Enter your demographic information as it appears on your enrollment form or as indicated on your ID card. Click Submit. Member Access to Online Services 24 Hours a Day, 7 Days a Week

2 visioncare plan What to expect from your vision plan: Your eyesight is nothing to take for granted. It s how we see a loved one s face clearly or a beautiful sunset. But your sight can begin to deteriorate over a long period of time without your knowing there is a problem. As with any other important asset like your home or car wouldn t you feel more at ease if you knew your routine eye care was covered by a company with decades experience helping people like you? With CompBenefits VisionCare Plan, you can take advantage of coverage you need for eye examinations and eyeglasses or contacts. See the Difference You can also choose to take advantage of VisionCare Plan s deep discount for LASIK surgery. And you won t have to hunt hard to find a doctor close to your home or work. The VisionCare Plan network includes some 20,000 ophthalmologist and optometrist locations one third of all private practitioners in the country. Yet, it doesn t mean you can t see an out-of-network doctor because VisionCare Plan offers benefits in-network or out-of-network. It s your choice. You ll find what you CompBenefits has made understanding and accessing your VisionCare Plan benefits simple. Just take a few moments to register at and you ll have access to our VisionPass, which is necessary to take with you to your eye doctor appointment. Plus, you ll see all of your benefits on screen, including the frequency of your benefits, frame and lens as well as contact lens allowances. You ll have access to our database of 20,000 eye doctor locations through our Provider Locator. SSVCP

3 Jacksonville University Open your eyes to high-quality vision care! The average family spends close to $600 each year on routine eye health care. Using CompBenefits VisionCare Plan, you will receive your routine eye health care with just a small copayment. CompBenefits VisionCare Plan provides benefits for covered: Eye health examinations Frames Eyeglass Lenses Contact Lenses Plus you will receive: LASIK surgery discount Preferred member pricing for other frame and lens options* When ordering from one of our network eye doctors, you will also receive in the year of your eye exam: A 20% discount on a second pair of eyeglasses A 15% discount on your contact lens fitting fee MONTHLY RATES SERVICE FREQUENCY COPAYMENTS Employee only: $ 6.50 Vision exam: Once every 12 months Exam: $10 Employee + family: $18.60 Lenses: Once every 12 months Materials: $25 Frame: Once every 24 months SAVINGS! SEE THE DIFFERENCE You can save money two ways with VisionCare. First, the cost of plan services and materials is discounted and prepaid. So except for any co-payments, you have no out-of-pocket expenses for covered services and supplies when you use one of our network doctors. Second, your coverage costs are deducted from your pay before any federal income or FICA taxes are taken out. This makes your taxable wage base lower, so you would pay less tax. Here s an example of how the plan helps you save over the course of a year: If You Get: You Pay: VisionCare Typical Doctor Retail Eye exam.00 $ Frame (designer style) Lenses: Bifocal Option (pink tint #1 or #2) Co-payments: $10 exam/$25 materials $ Premium ($6.50 monthly x 12) $ Pre-tax savings (assuming 15% tax bracket & 7.65% FICA) Total Cost $95.33 $ YOUR TOTAL SAVINGS THROUGH VISIONCARE: 70% OFF RETAIL In this example, you would have saved $ in vision care costs with VisionCare Plan. Keep in mind, however, that your actual savings will depend on your plan allowances, your actual premium, the doctors and materials you select, and your own tax situation. * This is not a schedule of maximum benefits. For example, the plan covers frames based on the manufacturer s wholesale price guide. So while the retail price of a covered frame may vary among plan doctors, the value of your covered frame stays the same. Typically, the wholesale frame allowance is equivalent to a retail price of $ You may be required to pay extra only if you choose a frame that exceeds the covered wholesale price.

4 Maximum Allowances Eye Exam Paid in full Lenses (per pair) Single Paid in full Bifocal Paid in full Trifocal Paid in full Lenticular Contact Lenses Paid in full Elective (fitting, follow-up & lenses) $105* Medically necessary** Paid in full Frame $40 wholesale Lasik*** Members receive benefits when services are received from a TLC Truvision network provider with the following preferred rates: Silver Package: $895/eye for Conventional LASIK Gold Package: $1,295/eye for CustomLASIK Platinum Package: $1,895/eye for CustomLASIK plus Bladeless LASIK (using IntraLase technology). Participating Doctor (After copayments/ Up to plan limits) Members will also receive a 10% discount off UCR charges at other preferred LASIK provider locations, and pay no more than $1,800 per eye for the Conventional LASIK procedure and $2,300 per eye for CustomLASIK. * This allowance is paid with the same frequency as lenses, in place of all other benefits. ** Medically necessary (prior authorization required) is defined as 1) following cataract surgery w/o intraocular lens; 2) correction of extreme visual acuity problems not correctable with glasses; 3) anisometropia greater than 5.00 diopters and asthenopia or diplopia, with spectacles; 4) Keratoconus; or 5) monocular aphakia and/or binocular aphakia where the doctor certifies contact lenses are medically necessary for safety and rehabilitation to a productive life. *** Plan members must first contact CompBenefits for a list of providers and to receive a Refractive Care ID card. This schedule shows only a few of the covered procedures. Please see your Benefit Administrator for a complete schedule. This schedule is intended for comparison purposes only. The benefits of each plan will be determined by the contract. For a complete listing of benefits and exclusions and limitations, please reference your certificate of coverage. Out-of-network benefits apply under the VisionCare Plan, but benefits are higher when a participating doctor is utilized. Limitations and Exclusions apply. HOW DOES VISIONCARE PLAN WORK? You can choose a network provider at Depending on your plan, either you or your doctor will download a VisionPass Form from You must use the form in the time specified for services*. Visit your doctor, who will provide you with a comprehensive eye exam and order prescribed eyeglasses or contacts, if necessary. Pay any copayments as well as any additional expenses for cosmetic items you have chosen. That s the end of your paperwork. CompBenefits pays the doctor directly for his or her professional services. It s as easy as that! * If you do not use your form in the time specified for services, you won t be able to download another until the next time you are eligible for benefits. However, you can request an extension from our Customer Care team at CAN I GET CONTACTS INSTEAD OF LENSES? Yes. If you prefer contacts instead of glasses, your vision exam is covered-in-full with your exam co-payment and VisionCare Plan provides a generous allowance of $ to be applied towards your fitting and follow-up fees as well as materials costs. The Contact Lens allowance in LIEU OF THE LENS / FRAME BENEFIT and is provided with the same frequency as your lens benefit. HOW DO I GET FURTHER QUESTIONS ANSWERED? You may contact CompBenefits Customer Care Department with any questions or concerns at: , Monday Thursday 8am-8pm; and Friday 8am-6pm EST. or locate us on the web at

5 frequently asked questions Q. What are CompBenefits VisionCare Plans? A. CompBenefits VisionCare Plans are network-based vision plans that emphasize high quality routine eye health care from independent eye care professionals. Services and materials are provided on a pre-paid basis, and the plans pay network doctors directly. VisionCare Plan members can also use non-network doctors if they wish. Q. How does VisionCare Plan work? A. Members simply select any in-network optometrist or ophthalmologist and make their appointments. At the time of the appointment, members pay only their co-payments and for any extra cosmetic options selected. There are no forms to complete or claims to file. Members can also choose an out-of-network provider. In this case, they pay their doctor at the time of the visit and submit receipts to CompBenefits for reimbursement. Benefits are paid according to a reimbursement schedule. Q. Are there any limitations to my vision benefit? A. Yes, there are a few. Oversized lenses, when prescribed, may be covered only when patient s face size indicates they are necessary. Blended and progressive lenses are not normally required for visual welfare and are generally excluded. Elective or cosmetic items such as photochromic lenses, fashion color-coated lenses and sun lenses are not normally covered. Q. Does VisionCare Plan exclude anything? A. Yes, some items and services are excluded. Orthoptics or vision training, subnormal vision aids or plano (non-prescription) lenses Replacement of lost or broken lenses, except at the regularly-scheduled plan intervals Medical or surgical treatment of the eyes Care provided through or required by any government agency or program,including Workers Compensation or similar law Q. What do I need to access my benefits? A. You ll need a CompBenefits VisionPass, which you can download from our Web site, You ll take it to your eye doctor, and he or she will file it for you. Some groups, however, may have a plan in which the eye doctor downloads your VisionPass for you. Check with your benefit administrator for more details on how you should obtain your VisionPass. Q. Can I go online to find out more about my plan or get assistance? A. Yes. You can visit to learn about your plan, to check your benefits, to use our Provider Locator, to send us an and more.

6 Vision Provider Directory Baker, Clay, Columbia, Dixie, Duval, Hamilton, Lafayette, Nassau, Saint Johns, Suwannee and Union Counties The providers listed in this brochure were participating with the plan at the time of printing. Please check with the doctor of your choice or call our Customer Care department at when making your appointment to make certain he or she is currently a member doctor. You may also visit our website at for a nationwide listing of providers. You must receive services from one of our participating providers in order to receive full benefits (as outlined in your vision care booklet). If you receive service from a provider who does not participate in the plan, you will receive reimbursement according to the non-panel reimbursement schedule established by your group. BAKER Macclenny Futch, OD, Mary M 31 S 6th St (904) Phillips, OD, Robert L 534 S 5th St (904) CLAY Green Cove Springs Reed, OD, Joanne F 401 Bay St (904) Keystone Heights Minesinger, OD, James H 260 S Lawrence Blvd (352) Middleburg Allen, OD, Margaret A 1545 Branan Field Rd Ste (904) Anguas, OD, Edwin N 1545 Branan Field Rd Ste (904) Orange Park Abshire, OD, Kyle D Abshire, OD, Kyle D Akel, OD, Edward F 195 Blanding Blvd Ste (904) Allen, OD, Margaret A 28 Blanding Blvd (904) Anguas, OD, Edwin N 28 Blanding Blvd (904) Ayer, OD, Mary J 1515 Business Center Dr Ste (904) Bowman, OD, Christina B Bowman, OD, Christina B Brown, OD, Nichole Y 4605 US Highway 17 Ste (904) Donovan, MD, John P Donovan, MD, John P Downer, MD, Donald M Downer, MD, Donald M Green, OD, David A Green, OD, David A Harris III, MD, Clarence M Harris III, MD, Clarence M Hoffman, OD, James R Hoffman, OD, James R Javier, OD, Melanie C Javier, OD, Melanie C Larson, OD, Karen R Larson, OD, Karen R Pecoraro, MD, Russell A Pecoraro, MD, Russell A Reed, OD, Keven C Reed, OD, Keven C Tamsett-Schmidt, OD, Kendra Ji 1515 Business Center Dr Ste (904) Wilcox Jr, MD, John D Wilcox Jr, MD, John D COLUMBIA Lake City Bedoya, MD, Eduardo M 876 SW State Road (386) Broome III, OD, Frank A 763 SW Main Blvd Ste (386) Broome, OD, Kimberly M 763 SW Main Blvd Ste (386) Cole, OD, Reaves C 621 SW Baya Dr Ste (386) Foreman, OD, Ronald R 763 SW Main Blvd Ste (386) Owens, OD, Julie L 763 SW Main Blvd Ste (386) DIXIE Cross City Minesinger, OD, James H 85 NE 351 Hwy (352) DUVAL Atlantic Beach Duperault Jr., OD, Herman M 447 Atlantic Blvd Ste (904) Grimshaw, OD, Richard S 447 Atlantic Blvd Ste (904) Popp, OD, Mark A 447 Atlantic Blvd Ste (904) Jacksonville Akel, OD, Edward F 5205 Normandy Blvd Ste (904) Akel, OD, Gary M 953 Lane Ave S (904) Bateh, OD, Norman S 1233 Lane Ave S Ste (904) Bateh, OD, Norman S 5162 Norwood Ave (904) Bowman, OD, Samuel T 806 Riverside Ave (904) Brown, OD, Jeffrey D 2255 Dunn Ave Ste 101B (904) Brown, OD, Larry G 2001 College St (904) Brown, OD, Monica 1420 Flagler Ave (904) Brown, OD, Monica 7051 Southpoint Pkwy Ste (904) Caperton, OD, Bruce M 1840 Dunn Ave Ste (904) Carvell, OD, Melanie J 8102 Blanding Blvd Ste (904) Cone, OD, Paul J 961 Cesery Blvd (904) Del Campo, OD, Mary Eliza 9400 Atlantic Blvd Ste (904) Derickson, OD, John C 8771 Perimeter Park Ct Ste (904) Duss, MD, Charles V 6207 Bennett Rd (904) Favale II, OD, Anthony F 953 Lane Ave S (904) Fulghum, OD, Paul T 4225 Lakeside Dr (904) Gerson, OD, Robert 3737 Blanding Blvd (904) Grimshaw, OD, Richard S Norwood Ave (904) Habashi, OD, Hanaa M 1325 San Marco Blvd Ste (904) Habashi, OD, Hanaa M 9560 Crosshill Blvd Ste (904) Hanna, OD, Muneer N 1704 Southside Blvd Ste (904) Hanna, OD, Muneer N 2292 Mayport Rd Ste (904) Horning, OD, James A 4788 Hodges Blvd Unit (904) Houser, OD, Frank E Atlantic Blvd Ste (904) Howell Jr., OD, Charles N 2115 University Blvd S Ste (904) King, OD, Colleen M 2255 Dunn Ave Ste 101B (904) Lancaster, OD, Charles S 6207 Bennett Rd (904) Lanier Jr., OD, James C 806 Riverside Ave (904) Laramie, OD, Tammy A 6816 Southpoint Pkwy Ste (904) Leinwohl, OD, Gayle P 9397 San Jose Blvd Ste (904) Liane, OD, Peter D 100 W Bay St (904) July, 2010

7 Mark, OD, Dorothy E 9397 San Jose Blvd Ste (904) Mark, OD, Dorothy E 9400 Atlantic Blvd Ste (904) McIntosh, OD, Daniel R 3840 Belfort Rd Ste (904) Miles, OD, David E 1403 Dunn Ave Ste (904) Miles, OD, William F 1403 Dunn Ave Ste (904) Mint, OD, Janet M 4131 Southside Blvd Ste (904) Phillips, OD, Robert L 1580 Blanding Blvd (904) Popp, OD, Mark A Norwood Ave (904) Potochick, OD, Anthony 2036 Forbes St (904) Powers, OD, Michael A 3546 Saint Johns Bluff Rd S Unit (904) Pullen, OD, Stephen M San Jose Blvd Ste (904) Rauchwarger, OD, Alan I 9397 San Jose Blvd Ste (904) Rauchwarger, OD, Alan I 9400 Atlantic Blvd Ste (904) Reardon, OD, Patrick L 961 Cesery Blvd (904) Roberts, OD, B W 8102 Blanding Blvd Ste (904) Schnauss, MD, Roy H 804 Margaret St (904) Schwartz, OD, Steven H 3 Shircliff Way Ste (904) Shearer, OD, Jeffrey D 9978 Old Baymeadows Rd Ste (904) Sherrill, OD, Donna D San Jose Blvd Ste (904) Shmunes, MD, Neil T 6207 Bennett Rd (904) Simmons, MD, Richard L 6207 Bennett Rd (904) Spurling, OD, Robert L 9119 Merrill Rd Ste (904) Stam, OD, Bryan A 100 W Bay St (904) Wagner, OD, Ellen Rogers 806 Riverside Ave (904) Watts, OD, James W San Jose Blvd Ste (904) Weitzen, OD, Amanda 4131 Southside Blvd Ste (904) Weitzen, OD, Jerome 213 N Laura St (904) Williams, OD, Chandra M N Main St Ste (904) Williams, OD, Chandra M 1420 Flagler Ave (904) Williams, OD, Chandra M 7051 Southpoint Pkwy Ste (904) Williams, OD, Gary O 5353 Soutel Dr Ste B (904) Wood, OD, Wayne W 806 Riverside Ave (904) Jacksonville Beach Domingo, OD, Patrick J 905 Beach Blvd Ste B (904) Duss, MD, Charles V rd St S Ste (904) Lancaster, OD, Charles S rd St S Ste (904) Shmunes, MD, Neil T rd St S Ste (904) Simmons, MD, Richard L rd St S Ste (904) Stam, OD, Bryan A 905 Beach Blvd Ste B (904) Tirado, OD, Alejandro M rd St N (904) NASSAU Callahan Marks, OD, Linda L US Highway (904) Fernandina Beach Crump, OD, Jay P 1411 S 14th St Ste G (904) SAINT JOHNS Jacksonville Dorado-Foster, OD, Grace 450 State Road 13 Ste (904) Fisher, OD, Erika Lee 100 State Road 13 Ste A (904) Fisher, OD, Gerald Hugh 100 State Road 13 Ste A (904) Laramie, OD, Tammy A 1631 Race Track Rd Ste (904) Ponte Vedra Beach Bowman, OD, Samuel T 120 A1A N Ste (904) Falden, OD, Allison 880 A1A N Ste (904) Falden, OD, David 880 A1A N Ste (904) Houston, OD, Gilbert 150 Professional Dr Ste (904) Lanier Jr., OD, James C 120 A1A N Ste (904) Wagner, OD, Ellen Rogers 120 A1A N Ste (904) Wolf, OD, Karen S 150 Professional Dr Ste (904) Wood, OD, Wayne W 120 A1A N Ste (904) Saint Augustine Akel, OD, Edward F 212 State Road (904) Horning, OD, James A 1835 US Highway 1 S Ste (904) Kapadia, OD, Diane L 161 Hampton Point Dr Ste (904) Kapadia, OD, Sharokh N 161 Hampton Point Dr Ste (904) Miles, OD, Charles 25 Deltona Blvd Ste (904) Miles, OD, David E 25 Deltona Blvd Ste (904) Miles, OD, Henry E 25 Deltona Blvd Ste (904) Womack Jr, OD, John T 1835 US Highway 1 S Ste (904) Saint Johns Akel, OD, Edward F 450 State Road 13 Ste (904) St Augustine Miles, OD, William F 25 Deltona Blvd Ste (904) SUWANNEE Live Oak Broome III, OD, Frank A 522 Ohio Ave S (386) Owens, OD, Julie L 522 Ohio Ave S (386)

8 LASIK & PRK Opening doors to better vision for thousands of people with affordable LASIK & PRK procedures.* reduced fees The LASIK and PRK procedures are available for plan members who are nearsighted or have astigmatism and wear glasses or contacts.** We have contracted with many of the finest facilities and eye doctors to offer these procedures at substantially reduced fees. Extensive publicity and positive patient experience have created the acceptance and growth of laser vision correction. Network doctors can help plan members understand these new procedures and provide access to our network of LASIK and PRK providers. Members receive substantial reductions when procedures are done by network providers. Members can use Lasik provider network doctors at a cost of no more than $1,800 per eye for Conventional Lasik procedures and $2,300 per eye for custom Lasik. Or they can use designated TLC Vision Centers for the Lasik Advantage program that have the following fixed prices: Conventional Lasik - $895 per eye Custom Lasik - $1,295 per eye Custom Lasik with IntraLase - $1,895 per eye easy access to service During your comprehensive eye health examination, your doctor can determine if you are a candidate for LASIK or PRK. If you qualify, the doctor can also make arrangements for the procedure with one of the centers that participates in this program. Plan members can also go directly to one of the participating providers. Your VisionPass Form or your VCP ID Card verifies your eligibility for LASIK and PRK discounts. In either case, you may obtain a VisionPass Form and list of providers from our website ( or by calling our Customer Care Department at *** To initiate services in the TLC Vision Advantage Program call This discount cannot be combined with any other discount or promotional offer. The Humana/CompBenefits LASIK and PRK Program is not affiliated with any medical or health plan. * Laser-assisted in-situ keratomileusis; photorefractive keratectomy. ** If qualified as a LASIK and PRK candidate by the network doctor *** Program availability and professional fees may vary based on location and regulatory approval. Humana/CompBenefits 1511 N. Westshore Blvd Suite 1000 Tampa, FL (800) (813) LSK 07/08

9 Group Name: Jacksonville University Please complete the following information: Benefits Enrollment Form Social Security No. Last Name First Middle Date of Birth Home Address Home Phone Gender City State ZIP Code Business Phone List All Your Eligible Dependents That Are To Be Covered First MI Last Sex Birth Date Spouse: Effective Date: Plan Code: Group Number VS3136 Your Address Agent Number PLEASE CHECK YOUR CHOICE Vision Plan Monthly Rates Employee Only $6.50 Employee + Family $18.60 I wish to enroll in the plan indicated above as offered through my employer. I understand that this is a minimum one (1) year contract. I hereby authorize my employer to deduct all applicable contribution amounts from my salary or other compensation for the plan year, and for future renewal period(s). I understand that such contribution rate is subject to change on the anniversary date of the plan. I hereby represent that all information furnished by me hereon is true and complete to the best of my knowledge. Signature: X Date: