Agent Guide

AWACV1017

Table of Contents

Affiliated Workers Association (AWA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Eligibility & Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2State Availability

Association Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Insurance Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7About the Carrier

Vision Benefits Vision NetworkHealthy Vision TipsLimitations & Exclusions

Frequently Asked Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Online Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Enrollment Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

1

About Us

AWA’s Approach

Who AWA Serves

Our Partners

Membership to Affiliated Workers Association (AWA) has its advantages. You are now part of a non-profit organization comprised of small business owners, self-employed professionals and entrepreneurs from all across America. AWA is committed to providing education, resources and benefits to help our members save money, time and grow their business.

As an AWA member, you receive valuable resources for information to help you navigate through the complexity of running a business. You also have access to industry-leading benefits to help you and your family stay healthy and reduce expenses in your daily life, like telemedicine, insurance and roadside assistance.

One word that defines the AWA’s commitment to their members: Empowerment. AWA works tirelessly to research resources and benefits that will help their members reduce overhead expenses and learn how to succeed in their business endeavors. AWA knows their members work hard for their money, and the AWA works hard for them. Seeking out the best benefit providers and assuring top-quality services is just part of the day-to-day business for the AWA.

AWA membership is as diverse as their population, ranging from a shop owner in Texas to a freelance web designer in Pennsylvania. Membership is open to small business owners, independent contractors and entrepreneurs ages 18 and over, and can extend to the entire family.

The AWA is proud to be a strategic partner with a national advocacy group, Small Business Majority, to support their members in small business growth and provide information on issues that impact small businesses, including government, health care reform, clean energy, and other areas.

2

Individuals may enroll in a AWA ClearView membership if they meet the following eligibility requirements:

• Reside in an available state

• Adults age eighteen (18) or above

• Dependent children covered to age 26

• Common Law Spouses and Domestic Partners are accepted

AWA ClearView Monthly Membership Rates*

MEMBER $17

MEMBER + SPOUSE $29

MEMBER + CHILD(REN) $27

MEMBER + FAMILY $37

* One-time $25 enrollment fee applies. Fee is waived when vision is added to an active AWA membership.

Eligibility/Rates

3

State Availability

AWA ClearView is NOT Available in: AK, HI, NY, WA.

Available

Not Available

MT

WY

UTCO

NM

HI

AZ

CA

NV

ID

OR

WA

ND

AK

SD

MN

IA

MO

AR

LA

MS AL GA

FL

SC

TN

NC

MDDE

NJ

RI

NY

VT

NH

ME

MA

CT

VAWV

PA

IL IN

WI

MI

OH

KY

NE

KS

OK

TX

AWA ClearView is Available in 46 states & D.C.

4

Association Benefits

5

Association Benefits39DollarGlasses.com

As one of the largest online optical sites, 39DollarGlasses.com is the most recognized and trusted name for prescription eyeglasses and sunglasses. Thousands of happy customers and their feedback have earned 39DollarGlasses.com the prestigious 5-Star rating in Yahoo! Shopping and an A+ Rating with the Better Business Bureau as an accredited business since 2002.

Members can save 70% or more when purchasing glasses online. 39DollarGlasses.com was developed by eye doctors to create an inexpensive method for people to acquire high-quality, complete prescription eyeglasses and sunglasses through its e-commerce website.

39DollarGlasses.com manufactures their eyewear solely in the United States using the same high-quality materials seen at more expensive establishments. They offer top brands, such as Varilux® no-line bifocals and Transitions® Lenses at a fraction of the typical retail cost.

Polycarbonate lenses are the most impact-resistant and lightest material made for eyeglasses. All lenses come with a scratch-resistant coating (on both sides of the lenses) and a 100% UV coating at no extra charge. As a finishing touch, all lens edges are polished.

Any of their stylish frames can be made into prescription sunglasses with the same discounts as regular eyewear. In fact, all of their frames can be purchased online as non-prescription or prescription sunglasses. Bifocal sunglasses are also available.

When members order from 39DollarGlasses.com, they are automatically enrolled in the EyeBucks Rewards program. 4% of their purchases will be deposited into their customer account for future purchases. Members simply go to “My Account” to see how much they have earned!

Thousands of dollars’ worth of eyeglasses has been donated by 39DollarGlasses.com to a number of charities and organizations, including the Lions Club International organization, the New York City public schools and the Kress Vision Program, all in an effort to assist those in need. They are an American company that believes in giving back to the community.

Eyeglasses

Lenses

Prescription Sunglasses

EyeBucks Rewards

Philanthropy

Experience

6

Association Benefits

AWA members will be amazed at how quickly their earnings add up! Once you have registered, you can invite friends and family to create their own accounts and take advantage of this great benefit.

Retail Benefits

Retail Benefits is an online shopping site with a wide array of offerings. Members can earn up to 40% cash back at more than 5,000 leading merchants. Save even more with coupons that can be used instantly at your favorite stores. As an association member, you and your family receive special pricing for stores, many with items that can prove beneficial to vision.

The Shopping Assistant Toolbar, which can be downloaded to any computer, allows you to search for a product or merchant right from your browser without having to visit the Retail Benefits site first. You can search for products and compare prices and earnings between stores from the comfort of your home!

Ways Retail Benefit Can Help Members Improve Their Eye Health:

• Receive up to 4.2% cashback at Office Depot for screen filters to help reduce eyestrain while using the computer

• Get up to 7.0% cashback for 39dollarglasses.com

• Enjoy cashback and discounts on contacts from BestContacts.com and ACLens

• Review a variety of sunglasses discounts available from brands like Ray-Ban and Sunglass Hut

• Find discounts for Vitamin A, an essential supplement for eye health, from stores like Puritan’s Pride and GNC

HealthFitLabs

HealthFitLabs is an online merchant that sells only the highest-quality natural vitamins, nutritional supplements, and bath and personal care products.

Visit www.HealthFitLabs.com to browse several different product search options including categories such as Healthy Lifestyle, Vitamins & Minerals, Bath & Personal Care, and Healthy Pets. Members can also search by health condition. For instance, they have supplements for Eye Health Support, as well as others like Blood Sugar Support, Mood Support and more. Or shop by brand name; there are 1,900 products available on their website. Most vitamins are available to ship within 24 hours. Members save an additional 20% off already reduced prices on their first order at checkout.

HealthFitLabs is dedicated to helping members meet their health goals at the best possible prices.

7

Vision Plan Benefits

8

About the Carrier

Since 1976, MESVision has provided outstanding vision care services to large and small employer groups through well-known insurance companies, health plans, preferred provider organizations and self-funded (administrative services only) plans.

A third party administrator focused on efficiently and effectively administering vision benefit programs, MESVision performs claims administration, eligibility verification, billing and collections, as well as customer service regarding all member and provider inquiries.

MESVision is a Preferred Provider Organization committed to developing and maintaining a strong vision provider network. With one of the largest and most comprehensive networks nationwide, members have their choice of a substantial panel of Ophthalmologists (MDs), Optometrists (ODs) or Opticians located throughout the United States, including some of the most popular retail optical chain locations. Participating providers are required to meet stringent quality of care and credentialing standards. Members utilize participating providers 98% of the time, due to the quality of vision care services.

Gerber Products – “the baby food people” – established Gerber Life Insurance Company as a separate subsidiary in 1967. The two companies share a common goal: to help parents raise happy, healthy children. For Gerber Life, this means providing quality life insurance especially for young families on limited budgets and people at every stage of life.

Today Gerber Life insures over 2 million people throughout the United States and Canada. The Company’s underwriting principles, persistent cost controls, and careful monitoring of policy reserves for future benefit payments combine to build stability that can be counted on … now and for the years to come.

Gerber Life Insurance Company has achieved A rating (Excellent) from A.M. Best.

9

Vision Benefits

Vision Service Participating Provider Benefit Amount Covered by the Plan

Non-Participating Provider Benefit Amount Reimbursed by the Plan 1

Annual Eye Exam

Frequency (based on date of service) Once every 12 months Once every 12 months

Deductible $10 $10

Member Benefit Covered in Full $40

Eye Glass Frames ²

Frequency (based on date of service) Once every 24 months Once every 24 months

Frames Up to $100 Retail $40

Deductible $25 $25

Eye Glass Standard Lenses (up to 61mm)

Frequency (based on date of service) Once every 24 months 3 Once every 24 months 3

Single Vision Covered in Full $30

Bifocal Covered in Full $50

Trifocal Covered in Full $65

Lenticular Covered in Full $125

Lens Options

Polycarbonate Lenses 4 Up to $85 $55

Progressive Lenses Up to $89.50 $65

Contact Lenses 5

Frequency (based on date of service) Once every 24 months 6 Once every 24 months 6

Elective Up to $100 Retail $100

Non-Elective (one pair) Covered in Full with Authorization $250

1 Less any applicable copay. 2 Retail frame benefits will be converted to wholesale or warehouse equivalent prices at category 5 or 6 provider locations, (please refer to the Plan’s website at

www.MESVision.com). The wholesale or warehouse equivalent may be approximately 30% less than the retail frame allowance; please confirm this benefit before ordering your eyewear.

3 12 months with one or more of the following prescription changes: • A change of 0.50 diopter or more in one eye, or total in both eyes.• A shift in the axis of the cylinder of 15 degrees, or less than 15 degrees on a graduated scale as the cylinder power increases over 0.75 diopter. • The graduated scale is based on the shift in the axis multiplied by the cylinder power resulting in a factor of 8 or more. Table available to provider on

request. 4 For Dependent Children through age 18. 5 This benefit is in addition to the comprehensive vision examination, but in lieu of lenses and frame. If contact lenses are for cosmetic or convenience purposes,

the Policy will pay up to the above stated amount toward the contact lens evaluation, fitting costs and materials. Any balance is your responsibility. If contact lenses are medically necessary, one pair is fully covered. Approval from MESVision is required. Please refer to your Policy if you require additional information.

6 Contact Lenses frequency is once every 24 months, or once every 12 months with a prescription change.

10

Additional Features (in Network)

Discounts

A 20% discount is available for cosmetic extras, such as tints, coatings and other add-on charges to standard lenses, after Covered Services are rendered. The discount may be applied to charges for the frame or contact lenses (except disposable or replacement contact lenses) over the stated allowances. The 20% discount also applies to additional pairs of glasses and/or pairs of standard contact lenses.

To determine whether a provider offers the 20% discount, an insured individual can review their Participating Provider Directory, call MESVision at (800) 877-6372 or visit www.mesvision.com.

Contact Lens Replacement by Mail Program

MESVision plan members can now order contact lenses online through our website. Ordering contacts is easy. You can use your benefit at checkout, no claim form required and any order over $50 ships free. Please visit www.MESVision.com/Optics to learn more.

LASIK Procedures

Discounts are available through LasikPlus and Qualsight Lasik for conventional and custom LASIK procedures. Please visit www.lasikplus.com/mes and qualsight.com/-mesvision to learn more.

Vision Benefits Vision Network

Helpful Hints for Eye Health

Foods that are rich in vitamin C, vitamin E, zinc, lutein, zeaxanthin, beta-carotene and omega-3 fatty acids to promote good eye health. Berries, spinach, carrots, sweet potatoes, salmon, trout, eggs and almonds can all help your overall eye health.

Safety glasses for sports and sunglasses to protect from the sun’s ultraviolet rays can all be fashionable and beneficial to your vision.

Use the 20-20-20 rule: Every 20 minutes look away from the screen to about 20 feet in front of you for 20 seconds to help reduce eyestrain.

Add foods

Wear protective eyewear

Give your eyes a rest

11

Vision Network

MESVision® has been providing Real Choice in exceptional vision care services to thou-sands of companies and millions of vision plan participants since 1976.

Using an In-Network doctor maximizes

your benefits

Members can receive care from any licensed Ophthalmologist, Optician, or Optometrist, but their benefits differ and their out-of-pocket costs will be higher with a non-network doctor. And In-Network doctors also file claims for members, saving them time and the hassle of paperwork.

For more information on your AWA ClearView Vision plan or to search for an MESVision® provider, visit www.MESVision.com or call (800) 877-6372.

LensCraftersWalmartTarget

Pearle VisionEyeMastersEyeGlass World

CostcoSam’s ClubSears Optical

Texas State OpticalVisionWorksAnd More ...

MESVision Provides Real Choice

Members now have access to one of the largest vision provider networks available in the United States with thousands of locations nationwide. You have thousands of Choices!

MESVision® providers can Choose eyewear from ALL brands and ALL materials available. They are not restricted to certain brands and optical laboratories as with other vision plan companies. The Choice is yours to shop and compare to receive the most value for your benefit dollar.

Members can Choose to utilize one provider for your examination and eyewear materials or you can Choose to receive your examination from one provider and your materials from another provider. The Choice is yours!

The MESVision® Network includes Real Choices in network vision care providers:• Independent Ophthalmologists (MD)• Independent Optometrists (OD)• Independent Opticians (OPT) • Optical Retail Chain Locations including …

Access

Shop and Compare

Flexibility

MESVision Network

12

Healthy Vision Tips

An eye exam is one of the best ways to protect your vision because it can detect eye problems at their earliest stage when they’re most treatable. Regular eye exams give your eye doctor a chance to help you correct or adapt to vision changes. Even if you think your eyes are healthy, you still need an eye exam from time to time. Here are some guidelines to follow for eye health:

Regular Eye Exams - Why Should You Get Your Eyes Examined?

Screening for eye disease should be conducted at:• Newborn to 3 months• 6 months to 1 year• 3 years• 5 years

Some factors may put your child at increased risk for eye disease. If any of these factors apply to your child, check with your eye doctor to see how often you should have a medical eye exam:

• Developmental Delay• Premature birth• Personal or family history of eye disease• Previous serious eye injury• Use of certain medications (check with you eye doctor)• Some diseases that affect the whole body (such as diabetes or HIV infection)

Have your child’s vision checked before he or she enters first grade. If your child has no symptoms of vision problems and doesn’t have a family history of vision problems, have your child’s vision rechecked every two years. Talk to your child’s eye doctor about what checkup schedule is best for your child.

If you don’t wear glasses or contacts, have no symptoms of eye trouble, don’t have a family history of eye disease and you don’t have a chronic disease, such as diabetes, that puts you at risk of eye disease, have an eye exam at the following intervals:

• Ages 20 to 29: one examination• Ages 30 to 39: two examinations• Ages 40 to 65: examination every two to four years• Ages 65 and over: examination every one to two years

If you do wear glasses or contacts, you’ll need to have your eyes checked yearly. And if you notice any problems with your vision, schedule an appointment with your eye doctor as soon as possible. Blurred vision, for example, may suggest you need a prescription change. A sudden increase in the number of floaters (dark circles darting through your vision) could suggest visionthreatening changes to your retina.

Children 5 Years and Younger

School Age Children and Adolescents

Adults

Sources: American Academy of Ophthalmology (AAO) www.aao.org, The Mayo Clinic www.mayoclinic.com

13

Limitations & Exclusions

LIMITATIONS

Covered Services paid up to the Schedule of Benefits:We may limit benefits, as shown in the Schedule of Benefits, for:

1. Contact lenses, except as specifically provided;

2. Contact lens fitting, except as specifically provided;

3. Eyewear when there is no prescription change, except when benefits are otherwise available;

4. Non-standard lenses or lens options including, but not limited to polycarbonate, progressive, photochromic, polarized, high-index, occupational, beveled, faceted, coated (i.e., anti-reflective, scratch, mirrored and UV), oversized exceeding the allowance for covered lenses or such custom lens options;

5. Tints, other than pink or rose #1 or #2, except as specifically provided;

6. New patient intermediate (follow-up) examinations: You should see the same doctor for both the comprehensive and intermediate (follow-up) examinations in order to receive the maximum benefit and to optimize continuity of care. When You elect to have a comprehensive examination and You are eligible for an intermediate examination or select a different provider to perform the intermediate (follow-up) examination, You will be responsible for the difference between the intermediate (follow-up) examination allowance and the comprehensive examination allowance; and

7. Non-prescription (plano) eyewear.

EXCLUSIONS

Non-Covered ServicesWe will not pay benefits for:

1. Any eye examination required by an employer as a condition of employment;

2. Care or treatment of a condition for which You are entitled to or eligible for benefits under any Workers’ Compensation Act or similar law.

3. Replacement contact lens insurance offered by providers, care kits or frame cases;

4. Covered services which began prior to the insured’s effective date, or after the benefit has terminated;

5. Covered Services for which You are not legally obligated to pay;

6. Covered Services required by any government agency or program, (federal, state or subdivision thereof );

7. Covered Services performed by a close relative or by an individual who ordinarily resides in the insured’s home;

8. Orthoptics, vision training or subnormal vision aids;

9. Services that are Experimental or Investigational in nature;

10. Any services provided in connection with war or any act of war, whether declared or undeclared, or condition contracted or accident occurring while on full-time active duty in the armed forces of any country or combination of countries.

11. Procedures that are not included in the Schedule of Benefits.

12. Any charge for services that the appropriate regulatory board determines were provided as a result of a referral prohibited by State Law.

13. Medical or surgical treatment of the eyes.

14. Any Covered Services provided by another vision policy; and

15. Replacement of lenses or frames which are lost, stolen or broken, except when benefits are otherwise available.

AWA ClearView MESVision Plan

Medical Eye Services (MESVision) P.O. Box 25209

Santa Ana, CA 92799

Locate participating providers at www.MESVision.com or

call (800) 877-6372

Regular Eye Exams - Why Should You Get Your Eyes Examined?

14

Frequently Asked QuestionsQ. Why is vision insurance important? Are eye exams really necessary?

A. Yes! Getting an annual eye exam is not just about glasses. An eye exam can detect eye health problems like glaucoma or cataracts, but it can also help identify early signs of diseases that impact the whole body- high blood pressure, diabetes and high cholesterol– just to name a few.

Q. At what age should children first visit the eye doctor?

A. The American Optometric Association recommends that children should have their first eye exam with an optometrist or ophthalmologist between six months of age and one year. The doctor will check for nearsightedness, farsightedness, astigmatism, amblyopia (or “lazy eye”), proper eye movement and eye alignment, how the eye reacts to light and darkness, and other eye health problems. They also recommend that their next eye exam should take place sometime between the ages of 3 and 5, and then every year after that. During these exams, the doctor will conduct a comprehensive eye exam as well as vision screening tests.

Q. When can members begin using their Vision and other benefits?

A. Members can begin using their benefits on their plan’s effective date, subject to the terms and conditions of the plan.

Q. Can members access their AWA ClearView plan membership information online?

A. Yes, membership includes access to our secure online Member Portal - members.affiliatedworkersassociation.org. Once logged in, members can view, download and print their member materials, including ID card, benefits guide and certificate, as well as access phone numbers, web links and information regarding their AWA ClearView plan membership.

Q. What is the vision network and how do members find participating providers?

A. Members can select a participating vision care provider at www.MESVision.com or by calling MESVision’s Customer Care Center at (800) 877-6372. When you make an appointment with the participating provider of your choice, inform them that you are a MESVision member and they will call to verfiy your eligible plan benefits.

Q. Can members get the same quality of care at a retail provider as they can at an independent doctor?

A. Absolutely. In fact, many of the optometrists who practice in retail settings share space with an optical store, but operate separately. All optometrists, regardless of the setting of their practice, must meet the same state licensing and credentialing requirements. In addition, due to the finite number of optometry schools in the United States, optometrists are trained consistently regardless of the practice model they eventually choose.

Q. Can members use their benefits to get laser vision correction?

A. Yes, discounts are available for conventional and custom LASIK procedures through our partners, LasikPlus and Qualsight Lasik. Visit their websites for more information (see page 10).

Q. Can members use their benefits when they order contacts online?

A. Yes, the contact lens benefit will apply to the purchase of contacts at their provider ’s office or online at www.MESVision.com/Optics. Ordering contacts online is easy. Members can use their benefit at checkout, with no claim form required and any order over $50 ships free.

Q. Do members need to submit claims?

A. When members visit one of MESVision’s in-network providers, the paperwork is all taken care of. If they see an out-of-network provider, they will need to pay at the time of service and complete a claim form to send to MESVision for reimbursement.

Q. Who can members call for help?

A. Please contact AWA’s Customer Service at (855) 351-7536 and one of our friendly representatives will be glad to help them!

15

Important Agent Note: Initial access to Member Portal requires a valid email address. Be sure to capture at time of enrollment.

Member Portal

Online Membership Access

All memberships include exclusive access to our online Member Portal, a secure, convenient website that helps members to manage their membership.

Visit: members.affiliatedworkersassociation.org

Through quick and easy access, members can:

• Review their benefit information, association benefits and account information

• Access benefit partner websites for valuable health care savings

• Download and print Member materials

• Update contact information

• Add a new form of payment

16

Enrollment Form

By signing below, I and the individuals named herein are eligible for membership. I understand that the vision Insurance benefits included in my membership are not intended as a replacement for major medical coverage. The benefits will not satisfy the individual mandate as defined by the Patient Protection and Affordable Care Act. The membership will not begin until the effective date shown on the Policy. I authorize the Affiliated Workers Association to collect any and all premiums for this membership. By signing below, I acknowledge that I have read, understand, and agree to the terms and conditions of membership as they have been presented to me.

ClearView Enrollment Form

SPOUSE & DEPENDENT INFORMATION(Write spouse’s name below if you are applying for Enrollee and Spouse or Enrollee and Family Plan; if no spouse or if spouse is not to be enrolled, put N/A or “None” in space below.)

Spouse’s Name Date of Birth * Social Security Number Gender (M/F)

Dependent Name Date of Birth * Social Security Number Gender (M/F)

Dependent Name Date of Birth * Social Security Number Gender (M/F)

Beneficiary * (Please print full name) Relationship

(The enrollee will be the beneficiary for his or her spouse and/or dependent children if dependents are enrolled unless designated otherwise.)

AWA CLEARVIEW MEMBERSHIP PLAN OPTIONS (One time $25 enrollment fee applies on the Stand-Alone membership)

Plan Type: Stand-Alone Add-On

Plan Tier: Member Member + Spouse Member + Child(ren) Member + Family

GROUP OR ASSOCIATION Affiliated Workers Association Requested Effective Date

* Fields are required.

Enrollee Name * Enrollee Address *

City * State * Zip *

Social Security Number Daytime Phone Number *

Date of Birth * E-mail Address *

Gender: Male Female

CREDIT CARD OR AUTOMATIC BANK DRAFT

Credit Card Type Card Number Expiration Date Security Code

Bank Name Routing Number Account Number

Applicant Signature Date

Agent Signature Agent Name (Print) Agent Number

I hereby enroll as a member of the Affiliated Workers Association (the “Association”). I appoint the Secretary of the Association in office at any particular time as my proxy to receive notice of and attend all meetings of the members and vote on my behalf and to otherwise act for me in the same manner and with the same effect as if I were personally present. This proxy shall be valid until revoked at any time prior to voting at any meeting by executing and delivering a written notice of revocation to the Secretary of the Association, by executing and delivering a subsequently dated proxy to the Secretary of the Association or by voting in person.

Are you an Entrepreneur, Self-Employed Professional or Independent Contractor? * Yes No

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