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2013 2014 Vision Care Plan

Eligibility Associates who are scheduled to work at least 30 hours per week and have also attained 60 days of continuous service are eligible to participate in the program described below. The effective date of participation will be the 1st of the month following attainment of 60 days of continuous service. Associates scheduled to work less than 30 hours per week and Temporary Associates are ineligible to participate in Mattress Firm benefit plans. Dependents Eligible dependents can enroll in Mattress Firms benefits plans; however, supporting documentation will be required to validate eligibility. Please contact the Benefits Department to determine the required supporting documentation. An eligible dependent includes: 1. 2. 3. 4. Spouse (not fianc, but your legal spouse as determined by applicable law) Common Law Spouse Legal Dependent An Associates child up to age 26 (birth, adoption, or stepchild) Qualified Medical Child Support Order United Healthcare Vision In Network $10.00 (one visit per plan year) $25.00 100% (one pair per plan year)

Plan Provisions Exam Co-pay Hardware Co-pay Lenses (Single ,Bifocal, Trifocal, Lenticular)

Contact lenses (fitting, follow-up & lenses (in lieu of glasses) Medically Necessary Contacts Frame Retail value

Up to $140.00

Non Network Up to $40.00 Up to $80.00 Single - up to $40.00 Bi-focal up to $60.00 Trifocal up to $80.00 Lenticular up to $80.00 Up to $150.00

100% Up to $130.00 (one pair per 24 months)

Up to $210.00 Up to $50.00

Additional information and Network providers at can be located at Monthly Cost to Associates Level of Coverage United HealthCare Vision Associate Only $6.50 Associate and Spouse $12.40 Associate and Child(ren) $13.00 Associate and Family $20.00

Information contained in this document are summarizations and not intended to replace the full details regarding eligibility, covered expenses, exclusions, limitations, definitions and other provisions of each plan contained in legal documents, handbooks and group contracts. Legal documents shall govern any differences.