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000849845 55-1092 (1/22) ® Registered Marks of the Blue Cross and Blue Shield Association. ® ́ Registered Marks and SM Service Marks are property of their respective owners. © 2022 Blue Cross and Blue Shield of Massachusetts, Inc., or Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. Blue Cross Blue Shield of Massachusetts complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, or gender identity. ATTENTION: If you don’t speak English, language assistance services, free of charge, are available to you. Call Member Service at the number on your ID card (TTY: 711 ). ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma. Llame al número de Servicio al Cliente que figura en su tarjeta de identificación (TTY: 711 ). ATENÇÃO: Se fala português, são-lhe disponibilizados gratuitamente serviços de assistência de idiomas. Telefone para os Serviços aos Membros, através do número no seu cartão ID (TTY: 711 ). Benefits you can see—from a company you trust Call customer service at 1-855-875-6948 . To locate an in-network provider, visit blue2020ma.com .* *Registration not required to search for providers. Questions? FAVORITE NATIONAL RETAILERS and many regional retailers. ONLINE SHOPPING OPTIONS • Glasses.com • Contactsdirect.com • Ray-Ban.com • Targetoptical.com • Lenscrafters.com Piggy-bank Special Offers for additional savings Find them at blue2020ma.com . SAVE ON HEARING EXAMS AND HEARING AIDS Offered by Amplifon Hearing, an independent company. To learn more about the savings available, visit amplifonusa.com/blue2020 . To get started, call 1-866-921-5367 . Chart-network Eye Trophy ACCESS TO ONE OF THE NATION’S LARGEST VISION NETWORKS THOUSANDS OF INDEPENDENT PROVIDERS AWARD-WINNING CUSTOMER SERVICE SM ® ́ ® ́

BCBS Vision Benefits Summary - Page 2 BCBS Vision Benefits Summary Page 1