Common use of Managed Care Clause in Contracts

Managed Care. Managed vision care networks that meet standards developed by the National Carriers' Conference Committee concerning quality of care, access to providers and cost effectiveness shall be established wherever feasible. Employees who live in a geographical area where a managed vision care network has been established will be enrolled in the network along with their covered dependents. Employees enrolled in a managed vision care network will have a point-of-service option allowing them to choose an out-of-network provider to perform any vision care service covered by the Plan that they need. The benefits provided by the Plan when services are performed by in-network providers will be greater than the benefits provided by the Plan when the services are performed by providers who are not in- network providers, including providers in geographic areas where a managed vision care network has not been established. These two sets of benefits will be as described in the table below. Plan Benefit In-Network Other Than In-Network One vision examination per 12- month period. 100% of reasonable and customary charges 100% of reasonable and customary charges up to a $35 maximum One set of frames of any kind per 24-month period 100% of reasonable and customary charges1 100% of reasonable and customary charges up to a $35 maximum One set of two lenses of any kind, including contact lenses, per 24-month period. 100% of reasonable and customary charges2 100% of reasonable and customary charges up to the following maximums: up to $25 for single vision lenses up to $40 for bifocals up to $55 for trifocals up to $80 for lenticulars up to $210 for medically necessary contact lenses up to $105 for 1 Patients who select frames that exceed a wholesale allowance established under the program may be required to pay part of the cost of the frames selected.

Managed Care. Managed vision care networks that meet standards no less stringent than those developed by the National Carriers' ’ Conference Committee concerning quality of care, access to providers and cost effectiveness shall be established wherever feasible. Employees who live in a geographical area where a managed vision care network has been established will be enrolled in the network along with their covered dependents. Employees enrolled in a managed vision care network will have a point-of-service option allowing them to choose an out-of-network provider to perform any vision care service covered by the Plan that they need. The benefits provided by the Plan when services are performed by in-network providers will be greater than the benefits provided by the Plan when the services are performed by providers who are not in- in-network providers, including providers in geographic areas where a managed vision care network has not been established. These two sets of benefits will be as described in the table below. : Plan Benefit In-Network Other Than In-Network One vision examination per 12- 12-month period. 100% of reasonable and customary charges cus- tomary charges. 100% of reasonable and customary cus- tomary charges up to a $35 maximum maximum. One set of frames of any kind per 24-month period period. 100% of reasonable and customary charges1 cus- tomary charges.1 100% of reasonable and customary cus- tomary charges up to a $35 maximum maximum. One set of two lenses of any kind, including contact lenses, per 24-month period. 100% of reasonable and customary charges2 cus- tomary charges.2 100% of reasonable and customary cus- tomary charges up to the following fol- lowing maximums: up to $25 for single vision lenses up to $40 for bifocals up to $55 for trifocals up to $80 for lenticulars up to $210 for medically necessary nec- xxxxxx contact lenses up to $105 for contact lenses that are not medically neces- sary. Where the employee or depen- dent requires only one lens. 100% of reasonable and cus- tomary charges.2 100% of reasonable and cus- tomary charges up to a maxi- mum of one-half of the maxi- mum benefit payable for a set of two lenses of the same kind. 1 Patients who select frames that exceed a wholesale allowance established under the program may be required to pay part of the cost of the frames selected. 2 Patients may be required to pay part of the cost of spectacle lenses of lens characteristics that are not necessary for the patient’s visual welfare. Moreover, patients who choose contact lenses in lieu of spectacles may be required by pay part of a contact lens evaluation fee and part of the cost of fitting and materials. Unless Amtrak elects to participate in the National Freight Industry Vision Plan, it is intended that the Amtrak Vision Care Plan will be administered by the Joint Medical Administration Committee (JMAC), which will bear the same responsibilities and perform the same functions as it does with respect to the AmPlan Medical Plan. The benefit changes listed above are not intended to preclude the parties from agreeing to modify the dental plan benefits in the current or future rounds of collective bargaining or to conclude the current negotiations on these benefits.

Managed Care. Managed vision care networks that meet standards developed by the National Carriers' Conference Committee concerning quality of care, access to providers and cost effectiveness shall be established wherever feasible. Employees who live in a geographical area where a managed vision care network has been established will be enrolled in the network along with their covered dependents. Employees who live in a geographical area where a managed vision care network has been established will be enrolled in the network along with their covered dependents. Employees enrolled in a managed vision care network will have a point-of-service option allowing them to choose an out-of-network provider to perform any vision care service covered by the Plan that they need. The benefits provided by the Plan when services are performed by in-network providers will be greater than the benefits provided by the Plan when the services are performed by providers who are not in- in-network providers, including providers in geographic areas where a managed vision care network has not been established. These two sets of benefits will be as described in the table below. Plan Benefit In-Network Other Than In-Network One vision examination per 12- month period. 100% of reasonable and customary charges 100% of reasonable examination per 12- and customary and customary month period. charges charges up to a $35 maximum One set of frames of any kind per 24-month period 100% of reasonable and customary charges1 100% of reasonable any kind per 24- and customary and customary month period charges1 charges up to a $35 maximum One set of two 100% of reasonable 100% of reasonable lenses of any kind, and customary and customary including contact charges2 charges up to the lenses, per 24-month period. 100% of reasonable and customary charges2 100% of reasonable and customary charges up to the following maximums: period. up to $25 for single vision lenses up to $40 for bifocals up to $55 for trifocals up to $80 for lenticulars up to $210 for medically necessary contact lenses up to $105 for contact lenses that are not medically necessary Where the employee 100% of reasonable 100% of reasonable or dependent and customary and customary requires only one charges 2/ charges up to a lens maximum of one-half of the maximum benefit payable for a set of two lenses 1 Patients who select frames that exceed a wholesale allowance established under the program may be required to pay part of the cost of the frames selected.

Managed Care. Managed vision care networks that meet standards developed by the National Carriers' Conference Committee concerning quality of care, access to providers and cost effectiveness shall be established wherever feasible. Employees who live in a geographical area where a managed vision care network has been established will be enrolled in the network along with their covered dependents. Employees who live in a geographical area where a managed vision care network has been established will be enrolled in the network along with their covered dependents. Employees enrolled in a managed vision care network will have a point-of-service option allowing them to choose an out-of-network provider to perform any vision care service covered by the Plan that they need. The benefits provided by the Plan when services are performed by in-network providers will be greater than the benefits provided by the Plan when the services are performed by providers who are not in- in-network providers, including providers in geographic areas where a managed vision care network has not been established. These two sets of benefits will be as described in the table below. Plan Benefit In-Network Other Than In-Network One vision examination per 12- month period. 100% of reasonable and customary charges 100% of reasonable examination per 12- and customary and customary month period. charges maximum charges up to a $35 maximum One set of frames of any kind per 24-month period 100% of reasonable and customary charges1 100% of reasonable any kind per 24- and customary and customary month period charges1 maximum charges up to a $35 maximum One set of two 100% of reasonable 100% of reasonable lenses of any kind, and customary and customary including contact lenses, per 24-month period. 100% of reasonable and customary charges2 100% of reasonable and customary charges up to the following maximums: up to $25 for single vision lenses up to $40 for bifocals up to $55 for trifocals up to $80 for lenticulars up to $210 for medically necessary contact lenses up to $105 for contact lenses that are not medically necessary Where the employee 100% of reasonable 100% of reasonable or dependent and customary and customary requires only one charges 2/ charges up to a lens maximum of one-half of the maximum benefit payable for a set of two lenses of the same kind 1 Patients who select frames that exceed a wholesale allowance established under the program may be required to pay part of the cost of the frames selected.

Managed Care. Managed vision care networks that meet standards developed by the National Carriers' Conference Committee concerning quality of care, access to providers and cost effectiveness shall be established wherever feasible. Employees who live in a geographical area where a managed vision care network has been established will be enrolled in the network along with their covered dependents. Employees enrolled in a managed vision care network will have a point-of-service option allowing them to choose an out-of-network provider to perform any vision care service covered by the Plan that they need. The benefits provided by the Plan when services are performed by in-network providers will be greater than the benefits provided by the Plan when the services are performed by providers who are not in- network providers, including providers in geographic areas where a managed vision care network has not been established. These two sets of benefits will be as described in the table below. Plan Benefit In-Network Other Than In-Network One vision examination per 12- month period. 100% of reasonable 100% of reasonable and per 12-minth period and customary charges 100% of reasonable and customary charges up to a $35 maximum One set of frames of any kind per 24-month period 100% of reasonable 100% of reasonable and any kind per 12-month and customary charges1 100% of reasonable and customary charges up to a period charges (1) $35 maximum One set of two lenses 100% of reasonable 100% of reasonable and of any kind, including and customary customary charges up to contact lenses, per 24-month period. 100% of reasonable and customary charges2 100% of reasonable and customary 24- charges up to the following maximums: month period. bifocals trifocals lenticulars medically necessary contact lenses contact lenses that are not medically necessary up to $25 for single simgle vision lenses up to $40 for bifocals up to $55 for trifocals up to $80 for lenticulars up to $210 for medically necessary contact lenses up to $105 for 1 Where the employee or 100% of reasonable 100% of reasonable and dependant requires only and customary charges customary charges up to a one lens (2) maximum of one-half of the maximum benefit payable for a set of two lenses of the same kind. 1) Patients who select frames that exceed a wholesale allowance established under the program may be required to pay part of the cost of the frames selected. 2) Patients may be required to pay part of the cost of spectacle lenses or lens characteristics that are not necessary for the patient's visual welfare. Moreover, patients who choose contact lenses in lieu of spectacles may be required to pay part of a contact lens evaluation fee and part of the cost of fitting and materials.

Managed Care. Managed vision care networks that meet standards developed by the National Carriers' Conference Committee concerning quality of care, access to providers and cost effectiveness shall be established wherever feasible. Employees who live in a geographical area where a managed vision care network has been established will be enrolled in the network along with their covered dependents. Employees enrolled in a managed vision care network will have a point-of-service option option, allowing them to choose an out-of-network provider to perform any vision care service covered by the Plan that they need. The benefits provided by the Plan when services are performed performed. by in-network providers will be greater than the benefits provided by the Plan when the services are performed by providers who are not in- in-network providers, including providers in geographic areas where a managed vision care network has not been established. These two sets of benefits will be as described in the table below. Other Than Plan Benefit In-Network Other Than In-Network One one vision 100!@ of reasonable 100'@. of reasonable examination per 12- and customary and customary month period. 100% of reasonable and customary charges 100% of reasonable and customary charges up to a $35 maximum One set of frames of any kind per 24-month period 1009o'- of reasonable 100% of reasonable any kind per 24- and customary charges1 100% of reasonable and customary month period charges' charges up to a $35 maximum One set of two 1006 of reasonable loot of reasonable lenses of any kind, and customary and customary including contact charges' charges up to the lenses, per 24-month period. 100% of reasonable and customary charges2 100% of reasonable and customary charges up to the following maximums: period. up to $25 for single vision lenses up to $40 for bifocals up to $55 for trifocals up to $80 for lenticulars up to $210 for medically necessary contact lenses up to $105 for 1 Patients who select frames contact lenses that exceed are not medically necessary where the employee 100@'. of reasonable 100% of reasonable or dependent and customary and customary requires only one charges 2/ charges up to a wholesale allowance established under the program may be required to pay part lens maximum of one-half of the cost maximum benefit payable for a set of two lenses of the frames selected.same kind

Managed Care. Managed vision care networks that meet standards developed by the National Carriers' Conference Committee concerning quality of care, access to providers and cost effectiveness shall be established wherever feasible. Employees who live in a geographical area where a managed vision care network has been established will be enrolled in the network along with their covered dependents. Employees who live in a geographical area where a managed vision care network has been established will be enrolled in the network along with their covered dependents. Employees enrolled in a managed vision care network will have a point-of-service option allowing them to choose an out-of-of- network provider to perform any vision care service covered by the Plan that they need. The benefits provided by the Plan when services are performed by in-network providers will be greater than the benefits provided by the Plan when the services are performed by providers who are not in- in-network providers, including providers in geographic areas where a managed vision care network has not been established. These two sets of benefits will be as described in the table below. Plan Benefit In-Network Other Than In-Network One vision examination per 12- month period. 100% of reasonable and customary charges 100% of reasonable examination per 12- and customary and customary month period. charges charges up to a $35 maximum One set of frames of any kind per 24-month period 100% of reasonable and customary charges1 100% of reasonable any kind per 24- and customary and customary month period charges1 charges up to a $35 maximum One set of two 100% of reasonable 100% of reasonable lenses of any kind, and customary and customary including contact charges2 charges up to the lenses, per 24-month period. 100% of reasonable and customary charges2 100% of reasonable and customary charges up to the following maximums: period. up to $25 for single vision lenses up to $40 for bifocals up to $55 for trifocals up to $80 for lenticulars up to $210 for medically necessary contact lenses up to $105 for contact lenses that are not medically necessary Where the employee 100% of reasonable 100% of reasonable or dependent and customary and customary requires only one charges 2/ charges up to a lens maximum of one-half of the maximum benefit payable for a set of two lenses of the same kind 1 Patients who select frames that exceed a wholesale allowance established under the program may be required to pay part of the cost of the frames selected.

Managed Care. Managed vision care networks that meet standards developed by the National Carriers' Conference Committee concerning quality of care, access to providers and cost effectiveness shall be established wherever feasible. Employees who live in a geographical area where a managed vision care network has been established will be enrolled in the network along with their covered dependents. Employees enrolled in a managed vision care network will have a point-of-service option allowing them to choose an out-of-network provider to perform any vision care service covered by the Plan that they need. The benefits provided by the Plan when services are performed by in-network providers will be greater than the benefits provided by the Plan when the services are performed by providers who are not in- in-network providers, including providers in geographic areas where a managed vision care network has not been established. These two sets of benefits will be as described in the table below. Plan Benefit In-Network Other Than In-Network One vision examination per 12- 12 month period. 100% of reasonable and customary charges 100% of reasonable and customary charges up to a $35 maximum One set of frames of any kind per 24-month period 100% of reasonable and customary charges1 100% of reasonable and customary charges up to a $35 maximum Plan Benefit In-Network Other Than In-Network One set of two lenses of any kind, including contact lenses, per 24-month period. 100% of reasonable and customary charges2 100% of reasonable and customary charges up to the following maximums: up to $25 for single vision lenses lenses; up to $40 for bifocals bifocals; up to $55 for trifocals trifocals; up to $80 for lenticulars lenticulars; up to $210 for medically necessary contact lenses lenses; up to $105 for contact lenses that are not medically necessary Where the employee or dependent requires only one lens 100% of reasonable and customary charges 2 100% of reasonable and customary charges up to a maximum of one-half of the maximum benefit payable for a set of two lenses of the same kind 1 Patients who select frames that exceed a wholesale allowance established under the program may be required to pay part of the cost of the frames selected.