Group Plan Summary FASNY

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1 Group Plan Summary FASNY Prepared by

2 Dental Access Plan powered by Aetna Dental Access Take advantage of savings offered by the Dental Access Plan powered by Aetna Dental Access, an industry leader in dental care. Vision and Prescription discount plans are also included. Dental Plan Advantages Save 15% to 50% on dental procedures including routine oral exams, cleanings and major work such as dentures, root canals & crowns Get 20% discount with the following specialists: Orthodontists (braces) Endodontists (extensive root canals) Prosthodontists (bridges and dentures) Periodontists (gums) Pediatric Dentists (for children) Oral Surgeons (major extractions) Cosmetic dentistry included such as bonding and veneers Include all members living in household on family plan Visit any participating dentist on the plan and change providers at any time No paperwork, health restrictions or referrals required

3 Dental Access Plan powered by Aetna Dental Access Frequently Asked Questions How much can I save using the plan? Our plan has the highest savings in the industry. You save 15%-50% immediately on the dental plan. How do I use the plan? Present your membership card to the dental provider. You will be charged the provider's Aetna Dental Access contracted fees. Who can I include in my plan? Anyone living in your household can be included. You can include your parents or other family members if you are responsible for them. How many times a year can I have my teeth cleaned? Unlimited! You can have your teeth cleaned as often as you wish. Low Member Rates One Member: $6.95 monthly Member Plus One: $11.95 monthly Member Plus Family: $15.95 monthly Providers in Your Area The Dental Access Plan powered by Aetna Dental Access has over 76,000 providers nationwide. In your area there are: General Dentists and 0 Specialists *See 1Dental.com/group for complete list Sample Fee Schedule from Aetna (for typical dental fees near in ) Procedure Typical 1 Fee Fee With Aetna Dental Access 2 Savings Oral Exam $87 $30 66% Full Mouth X-Ray $141 $76 47% Cleaning $107 $59 45% Filling (amalgam, 1 surface) $147 $80 46% Porcelain Crown (ADA Code 2752) $1111 $757 32% Root Canal (ADA Code 3310) $764 $455 41% Complete Upper or Lower Denture $1190 $901 25% Simple Extraction (ADA Code 7140) $184 $83 55% The sample table above contains a few common procedures discounted by Aetna Dental Access. The procedures discounted under Aetna Dental Access offer similar savings to the sample above, which reflects the average fee information currently available on our systems. The above fee schedule is only to be used as a guide to determine approximate prices for dental services in the applicable area. Individual dentist fee schedules may differ. Aetna makes no guarantee as to the accuracy of any particular fee amount. 1 Based on 80th percentile of the 2011 National Dental Advisory Service Comprehensive Fee Report. 2 Discounted fees are for visits to a participating general dentist. Members will be charged the provider's Aetna Dental Access contracted fees. Charges may vary from the sample fee schedule above. Consult with your provider prior to beginning any treatment. Lab fees are included.

4 EyeMed Vision Care Nationwide Vision Plan Save 20%-40% on the retail price on eye wear with your EyeMed Vision Care discount program. Members are eligible for discounts on exams, glasses and contact lenses at more than 40,000 providers nationwide. This plan is included with the Dental Access Plan powered by Aetna Dental Access at no additional charge. Standard Plastic Lenses*: Vision Care Services Single Vision $50 Bifocal $70 Trifocal $105 Frames: Any frame available at provider location Lens Options: UV Coating $15 Tint (Solid and Gradient) $15 Standard Polycarbonate $40 Standard Progressive Standard Anti-Reflective Coating Other Add-Ons and Services 35% off retail price $65 (Add to Bifocal) $45 Exam with Dilation as Necessary: 20% discount $5 off routine exam $10 off contact lens exam Contact Lenses: (Discount applied to materials only) Conventional Laser Vision Correction: Lasik or PRK from U.S. Laser Network 15% off retail price 15% off retail price 5% off promotional price Includes providers such as: Target Sears Optical Pearle Vision LensCrafters Other Value Added Services: Laser Vision Correction: EyeMed and LCA-Vision have arranged to provide this discount to all EyeMed members through one of the largest laser networks available, the US Laser Network. Members are entitled to 15% off the retail price or 5% off the promotional price of LASIK or PRK procedures, whichever is the greater discount. Simply call LASER6 to begin the process. Replacement Contact Lenses by Mail: EyeMed members may order replacement contact lenses at competitive prices via the Internet and have them mailed directly to your home. Simply visit for more information and a link to the ordering site. This service is for replacement contact lenses only, and your EyeMed discount does not apply. Your initial pair of contact lenses must still be purchased from your eye care provider to ensure proper fit and follow-up care. *Frame, lenses and lens options discounts apply only when purchasing a complete pair of eyeglasses. If purchased separately, members receive 20% off the retail price.

5 MedImpact Prescription Plan Nationwide Prescription Plan The MedImpact prescription discount plan works like other discount plans: Simply present your MedImpact membership card when purchasing your prescriptions and get an average of 15% to 25% on brand name drugs and an average of 15% to 60% on generic drugs. This plan is included with all dental plans at no additional charge Rx Plan Advantages Over 58,000 participating pharmacies nationwide Average savings of 15% to 60% on generic prescription drugs Average savings of 15% to 25% on brand-name drugs Save even more on maintenance medications through our convenient and money saving mail service at MedVantx Also receive discounts on over-the-counter medication with a written prescription from a prescriber A Snapshot of Participating Pharmacies: CVS Pharmacy Walgreens HEB Pharmacy Walmart Pharmacy Target Optical Rite Aid Pharmacy Albertsons Pharmacy Costco Pharmacy Medicine Shoppe Pharmacy

6 Dental Access Plan powered by Aetna Dental Access Here is a sample of General Dentists in Provider Phone Distance For a complete list of dentists in your area please visit mlonigro.caredp.com/provider/

Aubrey ISD. Dental Select Plan Rates for: For the benefit period running 09/01/2017 through 08/31/2018

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