Benefit Summary. Want to learn more? Additional Discounts and Features:

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1 Benefit Summary In-Network Out-of-Network Vision Care Services Member Cost Reimbursement Exam With Dilation as Necessary $10 Copay Up to $30 Contact Lens Fit and Follow-Up (Contact lens fit and two follow up visits are available once a comprehensive eye exam has been completed) Standard Contact Lens Fit & Follow-Up Up to $40 N/A Premium Contact Lens Fit & Follow-Up 10% off retail N/A Frames $0 Copay; $100 allowance; 80% of charge over $100 Up to $50 Want to learn more? For a complete list of providers near you, use our Provider Locator on and choose the SELECT network or call For Lasik providers, call LASER6. Additional Discounts and Features: 40% off additional eyewear purchases. 20% off non-prescription sunglasses. 20% off remaining balance beyond plan coverage. Laser vision correction - 15% off the retail price or 5% off the promotional price for LASIK or PRK procedures. Standard Plastic Lenses Single Vision $10 Copay Up to $25 Bifocal $10 Copay Up to $40 Trifocal $10 Copay Up to $55 Standard Progressive Lens $75 Up to $40 Premium Progressive $75, 80% of charge less $120 Allowance Up to $40 Lens Options (paid by the member and added to the base price of the lens) UV Treatment $15 N/A Tint (Solid and Gradient) $15 N/A Standard Plastic Scratch Coating $15 N/A Standard Polycarbonate $40 N/A Standard Polycarbonate - Kids under 19 $40 N/A Standard Anti-Reflective Coating $45 N/A Polarized 20% off retail price N/A Other Add-Ons and Services 20% off retail price N/A Contact Lenses Conventional $0 Copay; $115 allowance; 15% off retail price over $115 Up to $92 Disposable $0 Copay; $115 allowance; plus balance over $115 Up to $92 Medically Necessary $0 Copay, Paid in Full Up to $200 Laser Vision Correction Lasik or PRK from U.S. Laser Network 15% off retail price or 5% off promotional price N/A Frequency Examination Once every 12 months Lenses or Contact Lenses Once every 12 months Frame Once every 24 months MOE

2 Use your benefit and see great savings Cost for glasses with standard single-vision lenses With EyeMed Without Vision Coverage** Step 1: Step 2: Get an Eye Exam Pick a Frame (allowance $100) Selected a $170 frame (20% discount) $10 $0 $56 $88 $100 $70 Step 3: Pick a Lens Upgraded to Std. Polycarbonate Added Tint $10 $40 $15 $75 $62 $25 Step 4: Total Cost $131 $420 See the Savings $289, or a 69% savings Cost for glasses with standard progressive lenses With EyeMed Without Vision Coverage** Step 1: Step 2: Get an Eye Exam Pick a Frame (allowance $100) Selected a $170 frame (20% discount) $10 $0 $56 $88 $100 $70 Step 3: Pick a Lens Upgraded to Std. Polycarbonate Added Tint $75 $40 $15 $194 $62 $25 Step 4: Total Cost $196 $539 See the Savings $343, or a 64% savings Cost for disposable contact lenses With EyeMed Step 1: Step 2: Step 3: Without Vision Coverage** Get an Eye Exam Fit and Follow-Up Purchase Contact Lenses Allowance Total Cost $10 $40 $200 $115 $135 $88 $74 $200 $0 $362 See the Savings $227, or a 63% savings **Based on industry averages. Retail prices and costs will vary by market and provider type. Premiums not included. Visit EyeMedVisionCare.com to learn more. Benefits are not provided for services or materials arising from: Orthoptic or vision training, subnormal vision aids and any associated supplemental testing; Aniseikonic lenses; Medical and/or surgical treatment of the eye, eyes or supporting structures; Any eye or Vision Examination, or any corrective eyewear required by a Policyholder as a condition of employment; safety eyewear; Services provided as a result of any Workers' Compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof; Plano (non-prescription) lenses and/or contact lenses; Non-prescription sunglasses; Two pair of glasses in lieu of bifocals; Services or materials provided by any other group benefit plan providing vision care; Certain brand name Vision Materials in which the manufacturer imposes a no-discount policy; or Services rendered after the date an Insured Person ceases to be covered under the Policy, except when Vision Materials ordered before coverage ended are delivered, and the services rendered to the Insured Person are within 31 days from the date of such order. Lost or broken lenses, frames, glasses, or contact lenses will not be replaced except in the next Benefit Frequency when Vision Materials would next become available. Benefits may not be combined with any discount, promotional offering, or other group benefit plans. Standard/Premium Progressive Lens not covered - fund as a Bifocal Lens. Standard Progressive Lens covered - fund Premium Progressive as a Standard. MOE OEBC/A&H/0711

3 Mark Box To Waive Coverage Enrollment/Change Form Please print and complete all sections. See instructions below. Underwritten by Fidelity Security Life Insurance Company of Kansas City, Missouri EMPLOYER INFORMATION: To be Completed by Employer Group Number Employer Name Location Code Division Code Client Co Code Effective Date Scott Contracting Inc EMPLOYEE INFORMATION A: Add (enroll) T: Terminate C: Change (change of name, address or phone) ADD TERM CHG Sex M F Member ID Last Name (Employee or subscriber) First Name M.I. Date of Birth Social Security Number Home Street Address City/State/Zip Home Phone ( ) FAMILY INFORMATION (Only those eligible may be enrolled.) A: Add (enroll) T: Terminate C: Change (change of name) A T C Sex M F Last Name (spouse) First Name M.I. Date of Birth Social Security Number A T C A T C A T C A T C Sex M F Sex M F Sex M F Sex M F Last Name (dependent) First Name M.I. Date of Birth Social Security Number Last Name (dependent) First Name M.I. Date of Birth Social Security Number Last Name (dependent) First Name M.I. Date of Birth Social Security Number Last Name (dependent) First Name M.I. Date of Birth Social Security Number Employee Signature: Date: Instructions: Employer name: Legal name of the employer. Group Number: Provided by EyeMed or EyeMed representative. Location code: Optional field for employers to track multiple locations. Effective date: Date set by employer in accordance with EyeMed proposal. Employer also sets effective date for new adds during contract period. Family Information: List only eligible family members who are enrolling. Dependent eligibility is the same as employer s health plan. (A) Add: Open (group) enrollment or new (individual) enrollment during the contract period. (T) Terminate: To terminate enrollment. (C) Change: A change of name, employee address or employee phone. Once you elect EyeMed vision coverage, you cannot cancel for a 12-month period based upon your enrollment date. Deductions are adjusted according to payroll frequency.

4 CO CITY OF AURORA CHILDRENS EYE PHYSICIANS EAST 16TH AVE AURORA, CO KIDS CHOICE VISION E COLFAX AVE UNIT B AURORA, CO CITY OF BRIGHTON 2171 PRAIRIE CENTER PKWY BRIGHTON, CO CITY OF BROOMFIELD MAY EYE CARE 400 WEST 144TH AVE STE BROOMFIELD, CO CITY OF COMMERCE CITY NORTH RANGE EYE CARE E 104TH AVE STE COMMERCE CITY, CO CITY OF DENVER ADVENTURE VISION OF DENVER 1407 W 84TH AVE STE DENVER, CO BEST IN SIGHT EYECARE CENTERS 101 W 84TH AVE STE DENVER, CO CLEAR VISION EYE CARE MELODY DR DENVER, CO NORTH PARK VISION CENTER PC FEDERAL BLVD STE DENVER, CO CITY OF NORTHGLENN ABOUT EYES OPTOMETRY LLC Adams County MELODY DR DENVER, CO PEARLE VISION MELODY DR DENVER, CO CITY OF THORNTON BRIGHT EYES VISION CLINIC 550 E THORNTON PKWY STE DENVER, CO COLORADO EYE CENTER OPTOMETRY10001 N WASHINGTON ST DENVER, CO COLORADO EYE CENTER OPTOMETRY12450 YORK ST DENVER, CO E 120TH AVE DENVER, CO ONE HOUR OPTICAL 3867 E 120TH AVE DENVER, CO SEARS OPTICAL WASHINGTON ST BROOMFIELD, CO E 120TH AVE DENVER, CO VISTA EYE CARE COLORADO BLVD BRIGHTON, CO CITY OF WESTMINSTER ORCHARD PKWY BROOMFIELD, CO WESTMINSTER EYE ASSOC 8787 TURNPIKE DR STE WESTMINSTER, CO CITY OF ALAMOSA 2101 MAIN ST STE D ALAMOSA, CO ROCKY MOUNTAIN EYE CENTER 2509 MAIN STREET ALAMOSA, CO CITY OF AURORA Alamosa County Arapahoe County 365 TELLURIDE AURORA, CO ADVANCED EYE CARE CENTER 1399 S HAVANA ST STE AURORA, CO ALL ABOUT EYECARE E ILIFF AVE STE AURORA, CO AURORA FAMILY VISION 2220 S FREASER ST UNIT AURORA, CO AURORA VISION CENTER E HAMPDEN AVE STE AURORA, CO BUCKLEY OPTICAL CENTER E SIXTH AVE AURORA, CO CENTENNIAL EYE ASSOC E BRIARWOOD CIRCLE STE AURORA, CO COLORADO CATARACT & LASER LLC1411 S POTOMAC ST STE AURORA, CO ECLIPSE VISION SOURCE 6750 S CORNERSTAR WAY STE E AURORA, CO EYE CARE PLUS E SMOKEY HILL RD STE 10B AURORA, CO HERO VISION OF AURORA E MISSISSIPPI AVE AURORA, CO Visit for current provider information. Page 1

5 JCPENNEY OPTICAL E ALAMEDA AVE AURORA, CO NEW VISIONS OD PC 7562 S UNIVERSITY BLVD LITTLETON, CO E ALAMEDA AVE STE AURORA, CO OPTICAL MATTERS 7539 S UNIVERSITY BLVD LITTLETON, CO S MAIN ST STE 100 BLDG M AURORA, CO PEAK FAMILY EYE CARE 7000 S YOSEMITE ST STE ENGLEWOOD, CO S PARKER RD STE AURORA, CO PEARLE VISION 2370 E ARAPAHOE RD STE LITTLETON, CO LOOK OPTICAL 2621 S PARKER RD AURORA, CO PRO VISION EYECARE 7500 S UNIVERSITY STE LITTLETON, CO LOOK OPTICAL 3130 S PARKER RD AURORA, CO SEARS OPTICAL 7001 S UNIVERSITY BLVD LITTLETON, CO ONE HOUR OPTICAL 1113 S ABILENE ST AURORA, CO OPTIK SHOPPE 750 POTOMAC ST AURORA, CO PEARLE VISION E ALAMEDA AVE STE AURORA, CO PONDEROSA VISION CLINIC E HAMPDEN AVE STE AURORA, CO SEARS OPTICAL ALAMEDA AVE AURORA, CO SMOKY HILL EYE CARE E SMOKY HILL RD UNIT B AURORA, CO E ELLSWORTH AVE AURORA, CO THE OPTICAL GALLERY 4252 S CHAMBERS RD AURORA, CO THE VISION CENTER IN WAL-MART 5650 S CHAMBERS RD AURORA, CO VISION CARE SPECIALISTS E YALE AVE STE AURORA, CO VISION CARE SPECIALISTS PC 1550 S POTOMAC STE AURORA, CO VISION FIRST EYE CARE E ALAMEDA PKWY AURORA, CO CITY OF CENTENNIAL BUCKEYE VISION CARE 7960 S UNIVERSITY BLVD STE LITTLETON, CO EYE CARE CONSULTANTS 8586 E ARAPAHOE RD STE ENGLEWOOD, CO SOUTHGLEN EYECARE PC 6650 S VINE ST STE LITTLETON, CO CITY OF DENVER 4301 E VIRGINIA AVE DENVER, CO CITY OF ENGLEWOOD ADVANCED EYECARE CENTERS E ARAPAHOE RD ENGLEWOOD, CO BROOKRIDGE EYECARE 5116 S BROADWAY ENGLEWOOD, CO CHILDRENS EYE PHYSICIANS 9094 E MINERAL AVE STE ENGLEWOOD, CO DOVE VALLEY VISION CENTER PC E BRONCOS PKWY STE ENGLEWOOD, CO DR LEON F MILLER OD 3333 S BANNOCK ST STE ENGLEWOOD, CO ENGLEWOOD EYECARE 850 ENGLEWOOD PKWY STE 100A ENGLEWOOD, CO EYE LOGIC 123 A W HAMPDEN AVE ENGLEWOOD, CO HIGHLAND FAMILY OPTICAL 9094 E MINERAL AVE STE ENGLEWOOD, CO JEFFREY SPAHR OD 3350 S BROADWAY ENGLEWOOD, CO RIVERPOINT PARKWAY ENGLEWOOD, CO CITY OF GREENWOOD VILLAGE EUROPTICS INC 6010 SOUTH HOLLY STREET ENGLEWOOD, CO Visit for current provider information. Page 2

6 ONE HOUR OPTICAL 8547 E ARAPAHOE RD UNIT H ENGLEWOOD, CO VISION MASTERS 4920 SOUTH YOSEMITE UNIT C ENGLEWOOD, CO CITY OF LITTLETON BUTLER VISION CARE 7301 SANTA FE DR UNIT LITTLETON, CO EYETOPIA EYECARE 8089 S LINCOLN ST STE LITTLETON, CO SPECS APPEAL INC 2 W DRY CREEK CIR STE LITTLETON, CO WARREN L TAYLOR OD 3625 W BOWLES AVE STE LITTLETON, CO Archuleta County CITY OF PAGOSA SPRINGS 2800 CORNERSTONE DR STE A PAGOSA SPRINGS, CO Boulder County CITY OF BOULDER BENTON BRITT OD 805 S BROADWAY STE BOULDER, CO BOULDER VISION ASSOCIATES PC 5305 SPINE RD STE B BOULDER, CO CHILDRENS EYE PHYSICIANS 2800 FOLSOM ST STE C BOULDER, CO COLLEGE OPTICAL 1350 COLLEGE AVE STE BOULDER, CO DR PAULA POSTMA PC 2995 BASELINE ROAD STE BOULDER, CO FREDRIC IAN 2648 BROADWAY BOULDER, CO GOOSE CREEK OPTICAL 2800 FOLSOM ST STE D BOULDER, CO TH ST 1E BOULDER, CO PEARLE VISION 2795 PEARL ST STE BOULDER, CO VISIONS EYE CARE CENTER TH ST STE BOULDER, CO CITY OF LAFAYETTE EYE CARE CENTER OF NORTHERN CO300 EXEMPLA CIR LAFAYETTE, CO INSIGHT LASIK 300 EXEMPLA CIR STE LAFAYETTE, CO CITY OF LONGMONT ADVENTURE VISION OF LONGMONT1739 N MAIN ST LONGMONT, CO EYE CARE CENTER OF NORTHERN CO1400 DRY CREEK DR LONGMONT, CO FRONT RANGE EYE PHYS & SURGEON205 S MAIN ST STE D LONGMONT, CO LONGMONT VISION CENTER 412 MAIN ST LONGMONT, CO ROCKY MOUNTAIN RETINA ASSOC 1330 VIVIAN ST LONGMONT, CO SOUTH HOVER RD LONGMONT, CO THE OPTICAL CENTRE INC 521 MAIN ST LONGMONT, CO THIRD AVENUE EYECARE 800 THIRD AVE LONGMONT, CO CITY OF LOUISVILLE COLORADO EYE CENTER OPTOMETRY1371 E HECLA DR STE C LOUISVILLE, CO DR EDWIN JEUNG OD PC 1044 S 88TH ST STE LOUISVILLE, CO CITY OF SUPERIOR 400 MARSHALL RD LOUISVILLE, CO Broomfield County CITY OF BROOMFIELD 3D VISION INC 5760 W 120TH STE BROOMFIELD, CO CHILDRENS EYE PHYSICIANS 469 STATE HIGHWAY BROOMFIELD, CO COLORADO EYE CENTER LLC 4 GARDEN CENTER BROOMFIELD, CO COLORADO VISION SPECIALISTS 1 W FLATIRON CROSSING DR STE BROOMFIELD, CO WARREN TRIPP MD PC 2575 PEARL ST STE 1C BOULDER, CO Visit for current provider information. Page 3

7 EUROPTICS INC 265 E FLATIRON CROSSING DR BROOMFIELD, CO ELEVATED EYECARE PC 7305 E 29TH AVE DENVER, CO FRONT RANGE EYE ASSOICATES PC13605 XAVIER LANE STE G BROOMFIELD, CO EUROPTICS INC 100 FILLMORE ST DENVER, CO ONE W FLATIRON CIR STE BROOMFIELD, CO EUROPTICS INC 2960 EAST 2ND AVE SUITE C DENVER, CO PEARLE VISION 1285 E FIRST AVE STE D BROOMFIELD, CO Chaffee County CITY OF SALIDA ROCKY MOUNTAIN EYE CENTER 515 EAST 1ST ST SALIDA, CO CITY OF DELTA MORRIS OPTICAL 531 MAIN ST DELTA, CO CITY OF DENVER ACCENT OPTICS INC Delta County Denver County 2795 S COLORADO BLVD DENVER, CO AMERICAN VISION CENTER 26 S BROADWAY DENVER, CO ASSOCIATED EYE CARE 8101 E LOWRY BLVD STE DENVER, CO BRIGHT EYES FAMILY VISION CLIN 2250 SOUTH MONACO PKWY DENVER, CO CENTRAL DENVER EYE CARE 1041 ACOMA ST 1ST FLOOR DENVER, CO CHERRY CREEK OPTICAL INC 4999 EAST KENTUCKY AVENUE SUITE DENVER, CO COLORADO EYE CENTER LLC 1485 S COLORADO BLVD SUITE DENVER, CO COLORADO OPHTHALMOLOGY ASSOC1666 S UNIVERSITY BLVD DENVER, CO COLORADO VISION CARE 5026 E HAMPDEN AVE DENVER, CO DAVID DRUCKER MD TH ST STE DENVER, CO DOCTOR SPEX VISION CARE 6460 E YALE AVE STE A DENVER, CO EYE VISION DOWNTOWN TH ST MALL AND CHAMPA STE DENVER, CO EYES OF THE WORLD 1033 S GAYLORD ST DENVER, CO EYES OF THE WORLD 2036 E 17TH AVE DENVER, CO GOLDEN EYE OPTICAL LLC 1035 A S FEDERAL BLVD DENVER, CO HIGHLANDS EYECARE 4500 W 38TH AVE SUITE 130 BLDG J DENVER, CO HINES SIGHT 2480 S DOWNING ST STE G DENVER, CO ICON LASIK 3900 E MEXICO STE DENVER, CO ICON LASIK AND EYECARE 201 UNIVERSITY BLVD STE DENVER, CO INTERNATIONAL OPTIQUE 7800 E HAMPDEN AVE STE DENVER, CO LARRY D SUMNER OD 3400 E BAYAUD AVE STE DENVER, CO E FIRST AVE DENVER, CO NORTHFIELD BLVD STE DENVER, CO LOOK OPTICAL 2010 S UNIVERSITY DENVER, CO LOOK OPTICAL 4804 N CHAMBERS RD DENVER, CO MARKS OPTICAL 345 S COLORADO BLVD DENVER, CO MARKS OPTICAL 970 S ONEIDA ST STE DENVER, CO MAXWELL PEGG OPHTHALMOLOGY PC950 E HARVARD AVE STE DENVER, CO Visit for current provider information. Page 4

8 MID-CONTINENT OPTOMETRY PLLC4809 ARGONNE ST DENVER, CO OAKLEY CHERRY CREEK 3000 E FIRST AVE STE DENVER, CO ONE HOUR OPTICAL 1685 S COLORADO BLVD UNIT O DENVER, CO OPTICAL MASTERS 820 SOUTH MONACO PARKWAY SUITE 2B DENVER, CO OPTIQUE OF DENVER 1580 BLAKE ST DENVER, CO PEEPERS OPTICAL 5075 LEETSDALE DR DENVER, CO SEE INC 2800 E 2ND AVE DENVER, CO STACK OPTICAL SERVICES 3865 E CHERRY CREEK NORTH DR DENVER, CO STANLEY D HANSON OD 850 E HARVARD AVE SUITE DENVER, CO STAPLETON FAMILY EYE CENTER 2373 CENTRAL PARK BLVD STE DENVER, CO E 49TH ST DENVER, CO THE EYE CENTER 2480 S DOWNING ST STE DENVER, CO CITY OF CASTLE PINES CASTLE PINES EYECARE 250 MAX DR STE CASTLE ROCK, CO CITY OF CASTLE ROCK CASTEL ROCK EYE WEAR 856 HAPPY CANYON ROAD STE CASTLE ROCK, CO CASTLE ROCK VISION CLINIC 834-E S PERRY ST CASTLE ROCK, CO DR JAY PHILIPPE 201 S WILCOX STREET CASTLE ROCK, CO FOUNDERS PARKWAY VISION CENTER4344 WOODLANDS BLVD STE CASTLE ROCK, CO KERRY TYLER OD 409 S WILCOX ST CASTLE ROCK, CO PEARLE VISION CENTER 62 FOUNDERS PKWY STE E CASTLE ROCK, CO THE MEADOWS FAMILY EYE CARE 3750 DACORO LN STE Castle Rock, CO CITY OF HIGHLANDS RANCH EYE TO EYE CARE 9225 S BROADWAY UNIT A LITTLETON, CO HD EYECARE 8677 S QUEBEC STE A LITTLETON, CO HIGHLAND RANCH OPTICAL 9370 S COLORADO BLVD STE A LITTLETON, CO UNITED EYE CENTERS INC 950 E HARVARD AVE STE DENVER, CO HIGHLANDS RANCH VISION CENTER8925 S RIDGELINE BLVD STE LITTLETON, CO UNIVERSITY HILLS EYE CENTERS 2741 S COLORADO BLVD DENVER, CO VISION CARE SPECIALISTS PC TH ST DENVER, CO VISION CARE SPECIALISTS PC 2766 S WADSWORTH BLVD DENVER, CO VISION FIRST EYE CARE 200 QUEBEC ST BLDG 600A-STE DENVER, CO LOOCK PERFECT IMAGE EYECARE PC4008 RED CEDAR DR STE D LITTLETON, CO PEARLE VISION 9325 DORCHESTER ST STE LITTLETON, CO SGT JON STILES DR LITTLETON, CO THE VISION CENTER IN WAL-MART 6675 BUSINESS CTR DR LITTLETON, CO CITY OF AURORA Douglas County 7400 S GARTRELL RD AURORA, CO UNITED EYE CENTERS PC 9330 S UNIVERSITY BLVD STE LITTLETON, CO VISION CARE SPECIALISTS PC 200 W COUNTY LINE RD STE LITTLETON, CO Visit for current provider information. Page 5

9 CITY OF LONE TREE ADVANCED EYECARE CENTERS 9695 S YOSEMITE ST STE LONE TREE, CO ALAN J MARGOLIS MD PC RIDGE GATE PKWY STE LONE TREE, CO FRONT RANGE FAMILY EYECARE 9227 E LINCOLN STE LONE TREE, CO HELEN R WILSON OD PC 9220 KIMMER DR STE LONE TREE, CO JCPENNEY OPTICAL 8417 PARK MEADOWS LONE TREE, CO PARK MEADOWS CTR DR STE LITTLETON, CO OAKLEY PARK MEADOWS 8401 PARK MEADOWS CTR LONE TREE, CO PEARLE VISION CENTER 8441 S YOSEMITE STE LONE TREE, CO COMMONS ST LONE TREE, CO CITY OF PARKER COLORADO CATARACT & LASER LLC9399 CROWN CREST BLVD STE PARKER, CO GLAUCOMA CONSULTANTS OF CO LIONESS WAY STE PARKER, CO GREAT VISION 9835 S PARKER RD PARKER, CO INNOVATIVE EYECARE INC E PONDEROSA DR STE D PARKER, CO PARKER OPTICAL LLC S CROSSROADS DR STE PARKER, CO PARKER VISION SPECIALIST PC 9235 CROWN CREST BLVD STE PARKER, CO PEARLE VISION S DRANSFELDT STE PARKER, CO S TWENTY MILE RD PARKER, CO CITY OF BASALT BAUER EYECARE Eagle County 850 E VALLEY RD BASALT, CO CITY OF EAGLE EAGLE VALLEY VISION 313 CHAMBERS AVE UNIT C EAGLE, CO CITY OF EDWARDS VAIL VISION 1140 EDWARDS VILLAGE BLVD STE B EDWARDS, CO CITY OF CALHAN DR JAMES LEE El Paso County 560 CRYSTOLA ST CALHAN, CO CITY OF COLORADO SPRINGS 1030 E STEWART AVE STE COLORADO SPRINGS, CO LAKE PLAZA DR STE COLORADO SPRINGS, CO N CIRCLE DR COLORADO SPRINGS, CO MARTINEZ ST COLORADO SPRINGS, CO INC 4430 N NEVADA AVE COLORADO SPRINGS, CO INC 6220 WOODMEN PARK VIEW COLORADO SPRINGS, CO ACADEMY KIDS VISION 2436 S ACADEMY BLVD COLORADO SPRINGS, CO ACADEMY VISION SCIENCE CLINIC 5955 LEHMAN DR COLORADO SPRINGS, CO ACEDEMY KIDS VISION NORTH 4130 AUSTIN BLUFFS PKWY COLORADO SPRINGS, CO AKVC CENTRAL 883 N ACADEMY BLVD COLORADO SPRINGS, CO ALPINE VISION 4280 N ACADEMY BLVD COLORADO SPRINGS, CO AMERICAS BEST 1776 E WOODMEN RD COLORADO SPRINGS, CO ARCHDALE EYECARE PC 1541 S 8TH ST COLORADO SPRINGS, CO ARCHDALE OPTOMETRY CORPORATION7095 LEXINGTON DR COLORADO SPRINGS, CO BETTNER VISION INC 9205 N UNION BLVD STE COLORADO SPRINGS, CO Visit for current provider information. Page 6

10 BRIARGATE BLVD FAMILY VISION 1839 BRIARGATE BLVD COLORADO SPRINGS, CO GLENEAGLE VISION CENTER PC GLENEAGLE DR STE COLORADO SPRINGS, CO BRIGHT EYES VISION CLINIC 2360 SOUTH ACADEMY BLVD COLORADO SPRINGS, CO H RANDOLPH FRANK MD 6197 LEHMAN DR STE COLORADO SPRINGS, CO BROOKS OPTOMETRIC LLC 6799 BISMARK RD STE D COLORADO SPRINGS, CO I CARE PROFESSIONALS INC 4092 AUSTIN BLUFFS PKWY COLORADO SPRINGS, CO CHILDRENS EYE CENTER 4110 BRIARGATE PKWY STE COLORADO SPRINGS, CO IN SIGHT OPTICAL INC 12 E PIKES PEAK AVE COLORADO SPRINGS, CO CITADEL VISION 3510 GALLEY RD STE COLORADO SPRINGS, CO JCPENNEY OPTICAL 680 CITADEL DR EAST COLORADO SPRINGS, CO COLORADO EYE INSTITUTE 9320 GRAND CORDERA PARKWAY COLORADO SPRINGS, CO JOHN M CHRISTIANSEN MD PC 555 EAST PIKES PEAK STE COLORADO SPRINGS, CO COLORADO SPRINGS EYE CLINIC 2770 N UNION BLVD STE COLORADO SPRINGS, CO BRIARGATE BLVD STE COLORADO SPRINGS, CO COLORADO SPRINGS HEALTH 1625 MEDICAL CENTER POINT STE COLORADO SPRINGS, CO CINEMA POINT COLORADO SPRINGS, CO DR BENNETT BRIARGATE BLVD COLORADO SPRINGS, CO CITADEL DR EAST STE COLORADO SPRINGS, CO DR BRET W HARRISON 6140 TUTT BLVD STE COLORADO SPRINGS, CO MOUNTAIN SHADOWS VISION CTR 1910 VINDICATOR DRIVE STE COLORADO SPRINGS, CO DR JAMES LEE 2141 N ACADEMY CIR COLORADO SPRINGS, CO MOUNTAIN VIEW VISION 6071 E WOODMEN RD STE COLORADO SPRINGS, CO EAGLE EYE SOUTH 2750 S ACADEMY STE COLORADO SPRINGS, CO OPTICAL CENTER 1030 E STEWART AVE BLDG COLORADO SPRINGS, CO EAGLE EYES NORTH 1955 DOMINIAN WAY STE COLORADO SPRINGS, CO OPTICAL CENTER 6110 MARTINEZ ST COLORADO SPRINGS, CO EDDINGTON EYECARE 6130 BARNES RD STE COLORADO SPRINGS, CO PEAK VISION CENTER 3155 N UNION BLVD COLORADO SPRINGS, CO ELITE VISION PC 3470 CENTENNIAL BOULEVARD SUITE COLORADO SPRINGS, CO EUROPTICS 1685 BRIARGATES PKWY COLORADO SPRINGS, CO EXECUTIVE PARK EYE CARE LLC 9240 EXPLORER DR STE COLORADO SPRINGS, CO EYECARE CTR OF COLORADO SPRING1805 E CHEYENNE MOUNTAIN BLVD COLORADO SPRINGS, CO EYEGLASS WORLD 353 N ACADEMY BLVD COLORADO SPRINGS, CO FRONT RANGE EYECARE 5474 TOMAH DR COLORADO SPRINGS, CO PETERSON FAMILY EYECARE 6665 DEL MONICO DR STE A COLORADO SPRINGS, CO PIKES PEAK EYECARE 710 N CIRCLE DR COLORADO SPRINGS, CO PINE CREEK VISION CLINIC 9475 BRIAR VILLAGE PT STE COLORADO SPRINGS, CO RIDGEVIEW OPTOMETRY 8540 SCARBOROUGH DR STE COLORADO SPRINGS, CO ROCKRIMMON VISION CLINIC 6005 DELMONICO DR STE COLORADO SPRINGS, CO RONALD E MCELVAIN OD 358 MAIN ST COLORADO SPRINGS, CO Visit for current provider information. Page 7

11 SEARS OPTICAL 1650 BRIARGATE BLVD COLORADO SPRINGS, CO SEARS OPTICAL 2050 SOUTHGATE RD COLORADO SPRINGS, CO CITY OF WALSENBURG ROCKY MOUNTAIN EYE CENTER Huerfano County 100 W 4TH STREET WALSENBURG, CO BLOOMINGTON ST COLORADO SPRINGS, CO PROMINENT PT COLORADO SPRINGS, CO Jefferson County CITY OF ARVADA ARVADA HEALTH CENTER OPTICAL7950 KIPLING ST STE ARVADA, CO THE VISION CENTER IN WAL-MART 8250 RAZORBACK RD COLORADO SPRINGS, CO ARVADA OPTOMETRIC CENTER PC 7913 ALLISON WAY STE ARVADA, CO YOUR CHILDS EYES 2857 E FOUNTAIN BLVD COLORADO SPRINGS, CO LOOK OPTICAL 8737 SHERIDAN BLVD ARVADA, CO CITY OF MONUMENT MONUMENT VISION CLINIC 1860 WOODMOOR DR STE MONUMENT, CO CITY OF PEYTON ARBAUGH AND REUTER PC 7642 MCLAUGHLIN RD PEYTON, CO FALCON FAMILY EYE CARE PC 7685 MCLAUGHLIN RD STE PEYTON, CO CITY OF U S A F ACADEMY OPTICAL CENTER BLDG 5136 COMMUNITY CENTER DR U S A F ACADEMY, CO CITY OF ELIZABETH KAT EYES INC Elbert County 210 ELIZABETH STREET STE B ELIZABETH, CO Fremont County CITY OF CANON CITY CLAFLIN EYE CARE 1924 FRANKLIN AVE CANON CITY, CO ROCKY MOUNTAIN EYE CENTER 1145 OHIO AVE CANON CITY, CO SKYLINE VISION CLINIC 2776 E MAIN ST CANON CITY, CO SOUTHERN COLORADO EYE ASSOC326 DOZIER CANON CITY, CO Gunnison County CITY OF GUNNISON 420 N MAIN ST GUNNISON, CO MILE HIGH EYE CARE 8850 W 58TH AVE STE ARVADA, CO PEAK FAMILY EYE CARE W 64TH AVE ARVADA, CO CITY OF BROOMFIELD TOWN CENTER DR SP BROOMFIELD, CO REED ST BROOMFIELD, CO CITY OF CONIFER SIGHTLINES PLEASANT PARK RD STE CONIFER, CO CITY OF DENVER I CARE VISION CENTER 5560 W 44TH AVE DENVER, CO LOOK OPTICAL 5790 W 44TH AVE DENVER, CO CITY OF GOLDEN GOLDEN VISION CLINIC PC 2301 FORD STREET GOLDEN, CO TABLE MOUNTAIN VISION CLINIC 1409 WASHINGTON AVE GOLDEN, CO CITY OF LAKEWOOD ALL ABOUT KIDS VISION 2020 WADSWORTH BLVD LAKEWOOD, CO ALPINE VISION CENTER 8585 W 14TH AVE STE C DENVER, CO BEAR CREEK VISION CENTER 3190 SOUTH WADSWORTH BLVD STE DENVER, CO Visit for current provider information. Page 8

12 BRYAN VISION ASSOC 2525 S WADSWORTH BLVD STE DENVER, CO ADVANCED FAMILY EYECARE W KEN CARYL AVE UNIT L LITTLETON, CO COLORADO OPHTHALMOLOGY ASSOC11750 W 2ND PLACE STE 235 MEDICAL PLAZA DENVER, CO COLUMBINE EYECARE CENTER 1345 WADSWORTH BLVD DENVER, CO DENVER VISION 1535 S KIPLING PKWY UNIT C DENVER, CO DR SCOTTS OPTICAL OUTLET 2 98 WADSWORTH BLVD STE DENVER, CO DR THOMAS A POLITZER OD PC 333 S ALLISON PKWY STE DENVER, CO DRS MATOBA OPTOMETRISTS 200 UNION BLVD STE DENVER, CO EAGLE EYECARE 3355 S WADSWORTH BLVD STE G DENVER, CO EYECARE OF UNION SQUARE 390 UNION BLVD STE DENVER, CO FOOTHILLS VISION CENTER W ALAMEDA PKWY STE F DENVER, CO FOOTHILLS VISION CENTER W ALAMEDA PKWY STE B DENVER, CO AMERICAN VISION CENTER 8500 W BOWLES AVE SUITE LITTLETON, CO BELLEVIEW EYE ASSOCIATES INC 5104 S FIELD ST UNIT C LITTLETON, CO CHATFIELD EYE CARE SHAFFER DR BLDG M LITTLETON, CO COLUMBINE EYECARE CENTER 7335 S PIERCE ST LITTLETON, CO JCPENNEY OPTICAL 8501 WEST BOWLES LITTLETON, CO KEN-CARYL VISION 6179 S BALSAM WAY STE LITTLETON, CO W BOWLES AVE STE 1B LITTLETON, CO MARCIE GLASSNER OD W MEADOWS DR STE F LITTLETON, CO MEADOW VISION CENTER 9032 W KEN CARYL AVE UNIT A LITTLETON, CO PEARLE VISION 5132 SOUTH WADSWORTH BLVD STE LITTLETON, CO KIM C BROWN OD W ALAMEDA PKWY DENVER, CO SEARS OPTICAL 8501 W BOWLES AVE LITTLETON, CO W COLFAX AVE STE GOLDEN, CO SOUTHWEST EYE SPECIALISTS 9046 W BOWLES AVE UNIT G LITTLETON, CO W ALASKA DR DENVER, CO PEARLE VISION 7111 W ALAMEDA AVE STE L DENVER, CO SEARS OPTICAL W COLFAX AVENUE DENVER, CO W COLFAX AVE GOLDEN, CO THE VISION CENTER IN WAL-MART 7455 W COLFAX LAKEWOOD, CO CITY OF LITTLETON A TO Z EYE CARE 9862 WEST BELLVIEW AVENUE LITTLETON, CO W CROSS DR LITTLETON, CO CITY OF WESTMINSTER DAVID TRUMBO 9017 HARLAN ST WESTMINSTER, CO JCPENNEY OPTICAL 5453 W 88TH AVE WESTMINSTER, CO PEARLE VISION 5700 W 88TH AVE WESTMINSTER, CO THE VISION CENTER IN WAL-MART 9499 SHERIDAN BLVD WESTMINSTER, CO CITY OF WHEAT RIDGE BRIGHT EYES FAMILY VISION 5385 W 38TH DENVER, CO Visit for current provider information. Page 9

13 CHILDRENS EYE PHYSICIANS 4875 WARD RD STE WHEAT RIDGE, CO COLORADO VISION CTR FT COLLINS2001 S SHIELDS ST BLDG J FORT COLLINS, CO HERITAGE VISION CLINIC 6280 W 38TH AVE WHEAT RIDGE, CO DR RON BATEMAN AND ASSOCIATES373 W DRAKE RD STE FORT COLLINS, CO NANCY A HOULDER MD 3550 LUTHERAN PKWY STE 102A WHEAT RIDGE, CO EDGE OPTICS LLC 706 S COLLEGE AVE STE FORT COLLINS, CO NANCY A HOULDER MD 3555 LUTHERAN PKWY STE WHEAT RIDGE, CO EYE & LASER CTR FORT COLLINS 2121 E HARMONY RD STE FORT COLLINS, CO NORTHWEST EYE CENTER PC 4855 WARD RD STE WHEAT RIDGE, CO EYE CARE FOR YOU LLC 4050 TIMBERLINE RD UNIT FORT COLLINS, CO KIPLING ST WHEAT RIDGE, CO HARMONY EYE CARE CTR 181 WEST BOARDWALK STE FORT COLLINS, CO THE VISION CENTER IN WAL-MART 3600 YOUNGFIELD ST WHEAT RIDGE, CO MATTHEW J SKRDLA OD 712 WHALERS WAY STE A FORT COLLINS, CO THOMAS G BROOKES OD 4485 WADSWORTH STE WHEAT RIDGE, CO MTN VIEW EYE SPECIALISTS 2111 CUSTER DR FORT COLLINS, CO CITY OF DURANGO ENVISION DURANGO La Plata County 2855 N MAIN ST STE A DURANGO, CO PEARLE VISION 238 E HARMONY RD STE D FORT COLLINS, CO ROBERT J LARSON OPTOMETRIST 2001 S SHIELDS ST BLDG B STE FORT COLLINS, CO EYE CARE MANAGEMENT 765 E COLLEGE DR STE DURANGO, CO ROCKY MOUNTAIN FAMILY VISION 2105 BIGHORN DR STE FORT COLLINS, CO Larimer County CITY OF BERTHOUD BERTHOUND VISION CENTER 1211 LAKE AVE STE BERTHOUD, CO CITY OF ESTES PARK ASPEN EYE CENTER 600 S SAINT VRAIN STE ESTES PARK, CO CITY OF FORT COLLINS VISION CENTER 3501 S SHIELD ST FORT COLLINS, CO ABSOLUTE VISION 1015 SOUTH TAFT HILL RD FORT COLLINS, CO ADVANCED EYECARE 162 S COLLEGE AVE FORT COLLINS, CO BRIGHTER FUTURE VISION CLINIC 375 E HORSETOOTH RD BLDG 5 STE FORT COLLINS, CO COLORADO OPTOMETRY 4020 S COLLEGE AVE FORT COLLINS, CO SCOTT A HAUGEN OD 645 S WHITCOMB FORT COLLINS, CO COUNCIL TREE AVE FORT COLLINS, CO VILLAGE OPTICAL 4103 BOARDWALK STE FORT COLLINS, CO VISION EYELAND 1820 S COLLEGE AVE FORT COLLINS, CO CITY OF LOVELAND 20/20 OPTICAL & EYE CARE 2020 BLUE MESA CT LOVELAND, CO ASSOCIATES IN FAMILY EYECARE 2249 W EISENHOWER BLVD LOVELAND, CO CHILDRENS EYE PHYSICIANS 3650 E 15TH ST LOVELAND, CO DR ROGER A HULME OD PC 2677 N TAFT AVE LOVELAND, CO DRS LEE & LEE OPTOMETRISTS PC 2004 W 15TH ST STE LOVELAND, CO Visit for current provider information. Page 10

14 EISENHOWER EYECARE 1524 W EISENHOWER BLVD STE C LOVELAND, CO HORIZON VISION CENTER 2737 CROSSROADS BOULEVARD GRAND JUNCTION, CO ICON LASIK 3553 CLYDESDALE BLVD STE LOVELAND, CO ICON LASIK 120 WEST PARK DR STE GRAND JUNCTION, CO KIRK EYE CENTER 3650 E 15TH ST LOVELAND, CO PEARLE VISION 2424 HWY 6 AND 50 STE GRAND JUNCTION, CO SKY POND DR STE E LOVELAND, CO SEARS OPTICAL 2424 HIGHWAY 6 AND GRAND JUNCTION, CO PREMIER FAMILY EYECARE 1123 EAGLE DR LOVELAND, CO THE OPTICAL CENTER INC 1316 NORTH AVE GRAND JUNCTION, CO VAN'S EYECARE 1209 W EISENHOWER BLVD LOVELAND, CO CITY OF WELLINGTON EKLUND OPTOMETRIC GROUP 8251 WELLINGTON BLVD WELLINGTON, CO Las Animas County CITY OF TRINIDAD ROCKY MOUNTAIN EYE CENTER 2120 FREEDOM RD TRINIDAD, CO CITY OF HUGO DR JAMES LEE 111 SIXTH ST HUGO, CO CITY OF LIMON COLORADO EYE ASSOCIATES 269 EAST AVE LIMON, CO Logan County CITY OF STERLING CREATIVE EYEWORKS 100 BROADWAY ST STE STERLING, CO KIMS FASHION EYEWEAR LLC 502 W MAIN ST STERLING, CO THE VISION CENTER IN WAL-MART 1510 W MAIN STERLING, CO Mesa County CITY OF FRUITA VISUALEYES EYECARE PC 332 E ASPEN ST STE FRUITA, CO CITY OF GRAND JUNCTION FAIRMOUNT EYE CARE Lincoln County 3150 N 12TH ST GRAND JUNCTION, CO Montrose County CITY OF MONTROSE VISTA VISION FAMILY EYE CARE 2770 WOODGATE RD MONTROSE, CO CITY OF LA JUNTA 314 COLORADO AVE LA JUNTA, CO H RANDOLPH FRANK MD 1100 CARSON LA JUNTA, CO ROCKY MOUNTAIN EYE CENTER 102 SANTE FE AVE LA JUNTA, CO CITY OF ROCKY FORD FAMILY EYE CENTER 305 S MAIN ST ROCKY FORD, CO CITY OF HOLYOKE HOLYOKE EYECARE 111 W EMERSON ST HOLYOKE, CO CITY OF LAMAR Otero County Phillips County Prowers County 1500 S MAIN ST LAMAR, CO GAILA J AUSTIN OD PC 206 S FORTH ST LAMAR, CO Pueblo County CITY OF COLORADO CITY VALLEY EYECARE 4491 BENT BROTHERS BLVD PO BOX COLORADO CITY, CO Visit for current provider information. Page 11

15 CITY OF PUEBLO 900 W NORTHERN AVE PUEBLO, CO CITY OF ERIE ERIE FAMILY EYECARE 71 ERIE PKWY UNIT ERIE, CO INC 1650 W US HWY PUEBLO, CO DR VICTORIA PETERS & ASSOCIATE1700 W HWY PUEBLO, CO FAMILY EYE CENTER 712 FORTINO BLVD PUEBLO, CO JCPENNEY OPTICAL 3301 DILLON DR PUEBLO, CO ROCKY MOUNTAIN EYE CENTER 27 MONTEBELLO RD PUEBLO, CO ROCKY MOUNTAIN EYE CENTER 3954 SANDALWOOD LN PUEBLO, CO SOUTHERN CO EYECARE ASSOCIATES1620 FORTINO BLVD PUEBLO, CO SOUTHERN COLORADO EYE CARE 50 E HAHNS PEAK AVE UNIT C PUEBLO, CO Rio Grande County CITY OF MONTE VISTA DAVID N HINKLEY OD 37 WASHINGTON ST MONTE VISTA, CO Routt County CITY OF STEAMBOAT SPRINGS STEAMBOAT VISION CLINIC 130 N 9TH ST STEAMBOAT SPRINGS, CO Summit County CITY OF DILLON LAKE DILLON EYE CARE 325 LAKE DILLON DR STE DILLON, CO Teller County CITY OF WOODLAND PARK DR JAMES LEE W US HIGHWAY WOODLAND PARK, CO Weld County CITY OF EATON EATON VISION CLINIC LLC 215 ELM AVE EATON, CO SUMMIT VISION CARE INC 615 MITCHELL WAY STE ERIE, CO CITY OF FORT LUPTON FORT LUPTONVISION CENTER PC 301 DENVER AVE FORT LUPTON, CO CITY OF GREELEY ACHZIGER VISION CENTER ST AVE STE GREELEY, CO ADVENTURE VISION OF GREELEY 3485 C WEST 10TH ST GREELEY, CO APEX VISION AND WELLNESS TH AVENUE SUITE GREELEY, CO DRS LEE & LEE OPTOMETRISTS PC 3545 W 12TH ST GREELEY, CO PARKVIEW FAMILY EYECARE CENTER3545 W 12TH ST STE GREELEY, CO PEARLE VISION 1940 GREELEY MALL AVE GREELEY, CO SEE LIFE FAMILY VISION CENTER TH AVE STE A GREELEY, CO TERESA BEER OD TH AVE STE GREELEY, CO VISION CLINIC GREELEY PC TH AVE GREELEY, CO CITY OF JOHNSTOWN PRECISION FAMILY EYECARE PC 257 JOHNSTOWN CENTER DRIVE STE JOHNSTOWN, CO CITY OF WINDSOR ALPINE VISION 1550 MAIN ST STE WINDSOR, CO VISION REVISION 1292 MAIN ST # WINDSOR, CO WINDSOR EYE CARE & VISION CTR 515 MAIN STREET WINDSOR, CO Visit for current provider information. Page 12