Evaluating Your Option to Enroll
To help you decide if the vision plan is right for you, please consider the following:

1. Eligibility and enrollment guidelines. Click here for more information.

2. Length of the contract period. Once you are enrolled in the vision plan, you must remain enrolled through Dec. 31, 2010, even if you no longer need to use the plan (e.g., laser vision correction surgery).

3. Monthly premium rates. Click here for more information.

4. Plan features, coverage and exclusions. Click here for more information.

5. Participating VSP doctors in your area. Call VSP toll-free at 1-800-877-7195 or visit the Web site to obtain a list of participating VSP doctors.

Eligibility
Vision coverage is an optional plan available to benefit recipients, their spouse, dependent children and sponsored dependents. Enrollment or being eligible to enroll in an STRS Ohio health care plan is not required to enroll in the vision plan; however, the benefit recipient must be enrolled in the vision plan for any eligible dependents to participate.

Premiums for vision coverage are deducted monthly from your STRS Ohio benefit payment. If your monthly vision plan premium exceeds your STRS Ohio benefit payment, STRS Ohio will send you a bill for your monthly premium. Once enrolled in the vision plan, you must remain in the plan through Dec. 31, 2010, even if you no longer need to use the plan.

If you experience a life event, such as death, divorce, marriage, birth of a child, the addition of a dependent child or an enrolled dependent who no longer meets eligibility requirements, please contact STRS Ohio for an explanation of how the change will affect coverage for you and your dependents.

If you have questions about eligibility, contact STRS Ohio toll-free at 1-888-227-7877.

Enrollment Guidelines for Benefit Recipient, Spouse, Dependent Children and Sponsored Dependents
Review the following guidelines to determine if you are eligible to enroll. You may enroll yourself, a spouse, sponsored dependent or dependent children by calling STRS Ohio toll-free at 1-888-227-7877. To enroll sponsored dependents, completion of a sponsored dependent enrollment application is required.

No waiting period is required if you, your spouse, dependent children or sponsored dependents enroll within 31 days of terminating other group vision coverage. STRS Ohio coverage can be effective the first of the month following termination of other vision coverage if STRS Ohio receives and approves the request to enroll within the 31-day period.

A six-month waiting period is required if:

1. You and/or your dependents are not currently covered under a vision plan when the request to enroll is made; or

2. Your coverage under another vision plan is not terminating when the request to enroll is made; or

3. You fail to request enrollment for your dependents within 31 days of marriage, birth, legal guardianship, adoption or placement for adoption.

New Spouse
You may enroll a spouse by calling STRS Ohio. A waiting period may apply depending on whether other vision coverage is terminating. Coverage for a new spouse may be effective on the first of the month following the marriage, if a request to enroll is received within 31 days of the marriage date. A waiting period of six months will apply if the request to enroll is made after 31 days of marriage.

Child
You may enroll a newborn, adopted child or child for whom you are the legal guardian by calling STRS Ohio. STRS Ohio must receive the request to enroll within 31 days of birth, adoption, placement for adoption or legal guardianship. If dependent child vision coverage is currently in effect and a request to enroll is received later than 31 days following birth, adoption, placement for adoption or legal guardianship, coverage for the new dependent child is effective the first of the month after STRS Ohio receives the request. If a request to enroll is received later than 31 days following the date of the event and no other dependent children are enrolled, there will be a six-month waiting period.

Definition of Eligible Dependent
Eligible dependents who may qualify for vision coverage include:

• Benefit recipient’s spouse.

• A dependent biological child(ren) or a nonbiological child(ren)¹that is legally adopted, placed for adoption, a stepchild or a child for whom you have been appointed legal guardian and resides in your home and who meets the following eligibility requirements:

1. Unmarried and under age 18; or

2. Unmarried, under age 22 if the benefit recipient’s effective date of benefits was Jan. 1, 2003, or later, or under age 23 if the effective date of benefits was prior to Jan. 1, 2003, and the dependent is attending school²on at least a two-thirds-of-full-time basis and the benefit recipient is providing at least 50% or more financial support³; or

3. Unmarried and unable to earn a living because of a mentally or physically disabling condition that started before the date the child reaches the maximum age for dependent children as outlined above.

¹ If the child falls into this category, you must complete a Dependent Child’s Financial Status form, which shows you provide 50% or more financial support.

² If the child is attending school, you must complete a Student Status Verification for Health Care form.

³ If dependent children are survivors of a member who was receiving benefits at the time of death, the effective date of the member’s service retirement or disability benefit is used for determining the maximum age at which the children qualify for vision coverage.

Important Note: You must notify STRS Ohio in writing when a dependent child no longer meets eligibility requirements and indicate the day, month and year your dependent is no longer eligible. Premium deductions from your monthly STRS Ohio benefit payment do not guarantee coverage if your dependent no longer meets the eligibility requirements.

Definition of Sponsored Dependent
A child sponsored dependent and an adult sponsored dependent must meet the definition of a sponsored dependent as outlined below. In addition, a child sponsored dependent must be under age 18 and unable to qualify as a dependent child (outlined above). An adult sponsored dependent must be age 18 or older and unable to qualify as a dependent child or a spouse. Eligibility for sponsored dependent coverage is evaluated annually by STRS Ohio. To enroll a sponsored dependent, completion of an application is required. The application is available from STRS Ohio upon request. Sponsored dependents who may qualify for vision coverage include:

• A blood relative living in the home of a benefit recipient. “Home” includes a convalescent center or any other type of institution that retains the person only temporarily. To qualify as a blood relative, a person must have a direct genetic relationship to the benefit recipient, rather than a relationship through marriage.

• A blood relative not living in the home of the benefit recipient, but receiving 50% or more support from the recipient in the last six months (as demonstrated by completion of a financial status form provided by STRS Ohio or your most recent individual or joint federal income tax return on which you claimed your sponsored dependent).

• Any person (including the spouse of a survivor benefit recipient) living in the home of a benefit recipient and receiving 50% or more support from the survivor or benefit recipient in the last six months (as demonstrated by completion of a financial status form provided by STRS Ohio or your most recent federal income tax return on which you claimed your sponsored dependent).

• Any person living in the home of an unmarried service retirement or disability benefit recipient who does not claim the sponsored dependent as a financial dependent on the IRS tax return.

Important Note: You must notify STRS Ohio in writing when a sponsored dependent no longer meets eligibility requirements and indicate the day, month and year your dependent is no longer eligible. Premium deductions from your monthly STRS Ohio benefit payment do not guarantee coverage if your sponsored dependent no longer meets the eligibility requirements.

Effective Date of Coverage
The effective date of coverage is the first of the month following the date your request to enroll is received by STRS Ohio, or on the effective date of monthly retirement benefits — whichever is later. Enrollees will be covered through Dec. 31, 2010.

Please note there will be a six-month waiting period before vision coverage is effective if you are not currently covered under another vision plan or are enrolled in a vision plan that will not be terminating. Also, coverage is effective the first of the month following termination of other coverage only if STRS Ohio receives and approves your request to enroll within 31 days of the termination of your other vision coverage.

Premium rates

$7.61/month	Benefit recipient only.
$15.22/month	Benefit recipient & spouse; or Benefit recipient & one adult sponsored dependent.
$16.38/month	Benefit recipient & children; or Benefit recipient & children sponsored dependents; or  Benefit recipient, children & children sponsored dependents.

All Other Combinations of Enrollees

$23.99/month

Benefit recipient, spouse & children; or Benefit recipient, spouse & children sponsored dependents; or Benefit recipient, spouse & one adult sponsored dependent; or Benefit recipient, spouse, one adult sponsored dependent & children sponsored dependents; or Benefit recipient, adult sponsored dependent & children sponsored dependents, or Benefit recipient, spouse, one adult sponsored dependent, children & children sponsored dependents; or Benefit recipient, one adult sponsored dependent and children.

VSP Plan Features
VSP coverage is designed to protect your visual wellness. The plan provides different levels of coverage depending on whether you choose a VSP doctor or an out-of-network doctor. To maximize your vision coverage, use a VSP doctor (one that meets VSP’s strict quality standards). Please remember that your out-of-network doctor reimbursement rate does not guarantee full payment, and VSP cannot guarantee enrollee satisfaction when services are received from out-of-network doctors. The following chart summarizes the plan’s main features:

Plan Feature	Frequency	Copayment	Services from a VSP Doctor	Services from an Out-of-Network Doctor
Eye Exam	12 mo.1	$10	Covered in full after $10 copayment	Reimbursed up to $35
Lenses2	24 mo.1	$10	Covered in full after $10 copayment	Reimbursed up to $25 for single vision Reimbursed up to $40 for bifocal Reimbursed up to $55 for trifocal Reimbursed up to $80 for lenticular
Frames2	24 mo.1	$10	Covered in full, up to $130 retail allowance, after $10 copayment3	Reimbursed up to $35
Medically Necessary Contact Lenses4, 6	24 mo.1	$20	Covered in full after $20 copayment	Reimbursed up to $210
Elective Contact Lenses4, 5, 8	24 mo.1	$0	Covered up to $125	Reimbursed up to $125
Laser Vision Correction7		$0	Discounted services	None

¹Based on the date of your last exam.

²Your plan provides a 20% discount for additional noncovered complete pairs of prescription glasses.

³Your VSP coverage provides guaranteed savings whether you choose a frame that is covered by the retail allowance or one that exceeds it.  If you choose a frame valued at more than the plan’s retail allowance, you will receive a 20% discount on the amount over the allowance, and you will be responsible for the balance.

⁴Enrollees can use the plan to cover either contact lenses or frames and lenses.

⁵Your plan includes a 15% discount on the VSP doctor’s professional services when buying contact lenses. Materials are provided at the customary fees.

⁶Medically necessary contact lenses must be prescribed by a VSP doctor for certain conditions. Your VSP doctor must get prior approval from VSP for medically necessary contact lenses.

⁷Discounts on laser vision correction (PRK or LASIK surgery) are available through contracted laser centers. Program availability may vary based on location.

⁸Current soft contact lens wearers may qualify for VSP’s Contact Lens Care Program that includes a contact lens exam and initial lens supply. Visit www.vsp.com or ask your VSP doctor for details.

Coverage When VSP Doctors Are Used
While VSP offers members the freedom to receive services from any provider, when a VSP doctor is visited, members benefit from cost controls established with VSP doctors. Dollar-for-dollar you receive the best value from your VSP coverage when you visit a VSP doctor. If you decide not to see a VSP doctor, copayments still apply. You’ll also receive lesser coverage and typically pay more out-of-pocket.

Eye Exam
Covered in Full, Minus $10 Copayment

Lenses
Covered in Full, Minus $10 Copayment; Costs of Noncovered Options
VSP pays in full any necessary lenses, including single vision, bifocal, trifocal or other more complex lenses. Polycarbonate and progressive lenses are also covered by the plan.

Enrollees may elect lenses or lens characteristics that are not necessary for their visual welfare, but are desired for cosmetic reasons. Examples are tinted or photochromic lenses, scratch coating or blended bifocals. For all noncovered options selected, the enrollee is required to pay an additional cost. These cosmetic options are charged to the enrollee according to a cost-controlled price determined by VSP.

Frames
Wide Selection of Frames Covered in Full, Up to $130 Retail Allowance, Minus $10 Copayment; Added Cost if Enrollee Chooses a Frame Exceeding the Allowance
VSP provides a $130 retail allowance toward a new frame after a $10 copayment. If you choose a frame that costs more than the plan’s allowance, you will receive a 20% discount on the amount over your frame allowance, and you will be responsible for the balance.

Medically Necessary Contact Lenses
Covered in Full, Minus $20 Copayment
Medically necessary contact lenses are prescribed by a VSP doctor for treatment following cataract surgery, to correct extreme vision problems not correctable with prescription glasses, and for certain conditions of anisometropia and/or keratoconus. Medically necessary contact lenses require prior authorization by VSP.

Elective Contact Lenses
Covered in Full, Up to $125 Allowance
Elective contact lenses are chosen in lieu of lenses and frames. The eye exam is covered in full minus the $10 copayment. An allowance of $125 will be provided toward the contact lenses, fitting fees and any follow-up evaluations. Current soft contact lens wearers may qualify for VSP’s Contact Lens Care Program that includes a contact lens exam and initial lens supply. Visit www.vsp.com or ask your VSP doctor for details.

Additionally, VSP offers a 15% discount on contact lens professional services (evaluation, fitting fees and any follow-up evaluations). This discount applies only to professional services and does not apply to contact lenses. Any costs exceeding the $125 allowance are the enrollee’s responsibility. Under this plan, if the enrollee elects contact lenses, the enrollee will be eligible for a frame and lenses 24 months after obtaining the contact lenses.

Laser Vision Correction
Discounted Services
If you are considering laser vision correction, VSP can help you make an informed decision. VSP has contracted with many of the nation’s finest laser surgery facilities and doctors, offering you access to laser vision correction surgery for hundreds of dollars less than you might pay privately. On average, enrollees can receive 15% off the regular price or 5% off the promotional price from contracted facilities. After surgery, enrollees can use the frame allowance, if eligible, for sunglasses from any VSP doctor. Visit VSP’s Web site at www.vsp.com to learn more about this program.

Note: If you use laser vision correction coverage, you still must remain enrolled in the vision plan and pay premiums through Dec. 31, 2010.

Coverage When Out-of-Network Doctors Are Used
Services obtained through out-of-network doctors are subject to the same copayments and limits as services provided by VSP doctors as explained in the benefits chart. Bills for services from out-of-network doctors may be submitted to VSP for reimbursement up to the amounts shown in the benefits chart. Additionally, services obtained outside the United States are considered out-of-network. These claims will be converted to U.S. dollars and then processed.

VSP Added Value
No Claim Forms
Whenever you visit a VSP doctor, no claim forms are necessary. Providing your name and VSP identification number (the benefit recipient’s STRS Ohio ID number) are the only requirements.

Prescription Glasses
A 20% discount is applied to the VSP doctor’s usual and customary fees for additional noncovered pairs of prescription glasses when a complete pair is purchased within 12 months of the exam.

Contact Lenses
A 15% discount is available on the VSP doctor’s professional services when purchasing prescription contact lenses (at doctor’s usual and customary fees). This benefit is available in conjunction with the VSP contact lens allowance or can be used to purchase contact lenses in addition to glasses. Current soft contact lens wearers may qualify for VSP’s Contact Lens Care Program that includes a contact lens exam and initial lens supply. Visit the VSP Web site or ask your VSP doctor for details.

Discounted Prices

• Apply to the VSP doctor’s usual and customary fees.

• Are available for 12 months following the date of the covered eye exam; 20% off additional glasses and sunglasses, including lens options.

• Are offered only through the VSP doctor who last provided the covered eye exam.

• Apply only to professional services for prescription glasses and contact lenses.

• Do not apply to solutions or cleaning products.

Exclusions
This vision plan is designed to cover your visual needs rather than cosmetic materials. If any of the following options are selected, you will be responsible for the additional costs:

• Blended lenses

• Contact lenses (other than the normal frequency)

• Oversized lenses

• Photochromic or tinted lenses other than Pink 1 and 2

• Coated or laminated lenses

• Frames that exceed the allowance

• Certain limitations on low vision care

• Cosmetic lenses

• Optional cosmetic processes

• UV-protected lenses

The following professional services or materials are not covered. Discounts may apply to some items.

• Orthoptics or vision training and any associated supplemental testing

• Plano lenses (nonprescription)

• Two pairs of glasses in lieu of bifocals

• Medical or surgical treatment of the eyes

• Corrective vision services, treatments and materials of an experimental nature

Lenses and frames furnished under this program, which are lost or broken, will not be covered except at the normal intervals when benefits are otherwise available.

How to Use VSP Vision Coverage
While VSP offers members the freedom to receive services from any provider, when a VSP doctor is visited, members benefit from cost controls established with VSP doctors and pay less out-of-pocket for care.

Using your VSP vision plan is easy. Simply:

1. Find a VSP doctor by visiting the VSP Web site or call toll-free at 1-800-877-7195.

2. Make an appointment with your VSP doctor and give the following information:
   • Your name
   • Your VSP group name (State Teachers Retirement System of Ohio)
   • Your VSP identification number (the benefit recipient’s STRS Ohio ID number)
   • Your date of birth

   If you are making an appointment for a dependent, provide the dependent’s name and date of birth.

   Note: You will not receive a VSP identification card. Simply provide the information noted above when making your appointment.

3. Keep your scheduled appointment.

4. Pay any copayments. You are responsible for additional costs for cosmetic options or noncovered services. VSP and your VSP doctor will take care of the rest. Remember, when you visit a VSP doctor, there is no paperwork!

5. During your visit, ask whether the services and materials — such as eyewear — that you want are covered by VSP. Tints, special lenses and scratch-resistant coatings are some of the cosmetic options that may be available to you at discounted prices.
   

If you have coverage questions, contact VSP Member Services toll-free at 1-800-877-7195.

How to Locate a VSP Doctor
To locate a VSP doctor, use one of these easy methods:

• Call VSP Member Services toll-free at 1-800-877-7195 from 8 a.m. to 7 p.m. EST. After business hours and on weekends, an Interactive Voice Response system is available. Use your touch-tone phone to request a VSP doctor.

Note: Hearing impaired individuals can call VSP Member Services toll-free at 1-800-428-4833.

• Access VSP’s Web site.

If you are not currently enrolled, follow these steps:

1. Log on to the VSP Web site.

2. Select the “Find a Doctor” option.

3. Select “No” under the question, “Are you a VSP member?”

4. Enter the desired ZIP code and click the “Submit” button.

Once the information is submitted, a list of doctor names, addresses and phone numbers will appear on your screen.

If you are currently enrolled, follow these steps:

1. Log on to the VSP Web site.

2. Select the “Find a Doctor” option.

3. Select “Yes” under the question, “Are you a VSP member?”

4. Enter your identification number (the benefit recipient’s STRS Ohio ID number) in the Member ID field and your last name in the Last Name field.

5. Enter the desired ZIP code and click the “Submit” button.

Once the information is submitted, a list of doctor names, addresses and phone numbers will appear on your screen.

Questions And Answers About the VSP Vision Plan

Service

Can I see one VSP doctor for my exam and have my glasses made through another VSP doctor?
Yes. If you see two VSP doctors, you simply make an appointment for the exam with the VSP doctor of your choice, then make another appointment for materials with your other VSP doctor of choice. The VSP doctors will contact VSP directly to verify eligibility and plan coverage and to obtain authorization to provide services.

Note: If you want to have your prescription filled with a VSP doctor other than the one who performed the exam, please check with the VSP doctor’s office to ensure that it will fill another VSP doctor’s prescription.

What if I have an emergency, such as lost, stolen or broken glasses?
If an emergency arises, call VSP Member Services toll-free at 1-800-877-7195 and explain the situation to the representative. VSP will determine from your records if you are eligible for coverage. If so, make an appointment with a VSP doctor, who will call VSP to verify your eligibility for coverage.

If you elect to see an out-of-network doctor, submit to VSP your itemized receipts or attach them to a completed generic insurance or an HCFA-1500 form (available from your vision care doctor). Provided you are eligible for services, VSP will reimburse the claim according to VSP’s out-of-network doctor schedule of allowances.

Do I need a VSP identification card?
No. You do not need to present an identification card to confirm your eligibility, and no identification card will be sent to you. You should notify your doctor about your participation in the VSP vision plan. Your doctor can verify your eligibility by calling VSP Member Service toll-free at 1-800-877-7195.

What if I am dissatisfied with a VSP doctor or the materials received through a VSP doctor?
VSP guarantees enrollee satisfaction when seeing a VSP doctor. If you receive services or materials that are unsatisfactory, please contact VSP Member Services toll-free at 1-800-877-7195. VSP will review the situation and forward the resolution to you.

Coverage

If I am eligible for both an exam and eyewear (e.g., frames, lenses, etc.), but I choose to have only an exam, can I use my coverage for materials later in the year?
Yes. Please be aware that by receiving your exam and materials at different times during the year, you will be eligible only for a new exam 12 months from your last exam, and new lenses and a frame 24 months from your last purchase. Therefore, by “splitting up” your coverage, you may not be eligible for both an exam and materials at the same time the following year.

When seeing a VSP doctor, what type of frame selections will be covered in full by VSP?
VSP’s frame benefit covers a wide selection of frames on the market today. Because buying habits and tastes differ from one region to the next, frame inventories may vary from office to office. Your VSP plan provides guaranteed savings whether you choose a frame that is covered by the retail allowance or one that exceeds it. If you choose a frame that costs more than the plan’s retail allowance, you will receive a 20% discount on the amount over the allowance, and you will be responsible for the balance.

Am I eligible for contact lenses?
Yes. You may choose to obtain contact lenses instead of glasses. For elective contact lenses dispensed by a VSP doctor, the STRS Ohio plan provides up to a $125 allowance toward contact lens materials, any contact lens exam and fitting fees. In addition, coverage includes the standard vision exam in full, after you pay the $10 copayment.

You will also receive a 15% discount off the fitting and evaluation exam. This makes the allowance comparable to VSP’s payment for lenses and a covered frame. You are eligible for contact lenses every 24 months. Coverage for contact lenses can be used in place of coverage for lenses and a frame for this 24-month period.

For contact lenses dispensed by an out-of-network doctor, the same allowance will be provided for contact lenses, fitting and evaluation fees. However, the 15% discount on professional fees is not available, and the maximum reimbursement from VSP for elective contact lenses provided by an out-of-network doctor is $125.

What types of elective contact lenses may I receive through VSP?
As long as your elective contact lenses contain a prescription, your allowance remains the same for all types of contact lenses ($125). If the contact lenses, fitting and evaluation fees exceed $125, you are responsible for the payment of any remaining balance. VSP has guidelines and limitations regarding certain disposable contact lens materials. Please contact VSP Member Services toll-free at 1-800-877-7195 for more information.

Are my dependents also responsible for the payment of the plan copayment?
Yes. Your covered dependents are responsible for paying the copayment at the time covered services are obtained.

What benefits are provided when I choose to see an out-of-network doctor?
If you choose to see an out-of-network doctor, VSP will reimburse you up to the amounts allowed under the out-of-network doctor reimbursement rates of the STRS Ohio plan. (See the benefits chart above.)

Please remember that your out-of-network doctor reimbursement rates do not guarantee full payment, and VSP cannot guarantee enrollee satisfaction when services are received from out-of-network doctors.

When I see an out-of-network doctor, how is the bill handled?
When seeing an out-of-network doctor, pay the entire bill and gather the following information:

• Out-of-network doctor’s bill, including a detailed list of the services received

• Covered benefit recipient’s VSP member identification number (benefit recipient’s STRS Ohio ID number)

• Patient’s name, date of birth, phone number and address

• Covered benefit recipient’s name, phone number and address

• Name of the organization that provides your VSP coverage (State Teachers Retirement System of Ohio)

• Relationship to the covered STRS Ohio benefit recipient (such as self, spouse, child, etc.).

Note: You may also submit this information on a completed generic insurance form or a HCFA-1500 form (available from your vision care doctor).

Claims must be filed with VSP within six months after seeing the out-of-network doctor.

Please keep a copy of the information for your records and send the originals to:

Vision Service Plan
Attn.: Out-of-Network Provider Claims
P.O. Box 997105
Sacramento, CA 95899-7105

Contact VSP Member Services toll-free at 1-800-877-7195 for more information.

What are some of the cosmetic options that may require me to pay out-of-pocket expenses?
Some examples of cosmetic options are:

• Scratch coating

• Anti-reflective coating

• Photochromic and tinted lenses (except Pink 1 and 2)

• Oversized lenses (61mm or greater)

• Any frame that exceeds your plan allowance

These cosmetic options will not be covered in full by VSP. Due to agreements with VSP doctors and laboratories, some noncovered services may be provided at a discounted cost.

If I no longer need corrective lenses because my vision is corrected through laser vision correction, will I be able to disenroll from the VSP vision plan?
No. You must remain enrolled in the vision plan and pay premiums through Dec. 31, 2010, even if you no longer need to use the plan.

Why must I be enrolled in the plan through Dec. 31, 2010?
This requirement allows STRS Ohio to offer a lower cost plan and helps ensure that STRS Ohio can continue to offer this optional coverage in the future.

Contact Information
Call VSP’s Member Service Department toll-free at 1-800-877-7195 for all coverage-related questions or visit its Web site: www.vsp.com.

Contact STRS Ohio Member Services Center toll-free at 1-888-227-7877 for all eligibility questions.