The Vision Plan 1/1/2014 The Vision Plan 3 Important Terms As you read this summary of the JPMorgan...

Effective 1/1/2014 The Vision Plan 1

The Vision PlanThe Vision Plan helps you and your family pay for covered vision expenses, suchas eye exams, prescription glasses (lenses and frames), and contact lenses.

This section of the Guide will provide you with a better understanding of how yourVision Plan coverage works, including how and when benefits are paid.

Update: Your Guide toBenefits atJPMorgan Chase

This document is yoursummary plandescription of theJPMorgan Chase VisionPlan. The U.S.Department of LaborrequiresJPMorgan Chase toroutinely provide benefitsplan summaries to planparticipants. Pleaseretain this information foryour records. Thisdocument alsoconstitutes the plandocument for the VisionPlan.

This document does notinclude all of the detailscontained in theapplicable insurancecontracts. If there is adiscrepancy between theapplicable insurancecontracts and thisdocument, the insurancecontracts will control.

Questions?For live help through a customerservice representative, call theVision Plan’s Claims Administrator:VSP® Vision Care (VSP):y 1-855-846-7231Service Representatives areavailable Monday through Friday,from 8 a.m. to 11 p.m. EasternTime, and Saturday and Sunday,from 10 a.m. to 10 p.m. EasternTime. For questions aboutenrollment and eligibility, contactthe Benefits Call Center:y 1-877-JPMChase

(1-877-576-2427)y Quick Path: Enter your Standard

ID or Social Security number;press 1; enter your PIN; press 1.

If calling from outside the UnitedStates:y 1-212-552-5100 (GDP#

352-5100)Service Representatives areavailable Monday through Friday,from 8 a.m. to 7 p.m. Eastern Time,except certain U.S. holidays.

You can also obtain answers toyour questions 24 hours a day,seven days a week online atMy Health. My Health providesone-stop access to your healthcare benefits information. Simplyuse your Single Sign-On passwordto access the Benefits Web Centerfrom My Health. Go to MyHealth > Other Benefits > BenefitsWeb CenterFrom work: My Health from theintranetFrom home:myhealth.jpmorganchase.com(also available for your coveredspouse/domestic partner)

http://myhealth.jpmorganchase.com/


In This Section PageImportant Terms .................................................................................................................................. 3Some Quick Facts ............................................................................................................................... 5Participating in the Vision Plan .......................................................................................................... 6

Eligibility........................................................................................................................................... 6Coverage Categories ....................................................................................................................... 7Your Eligible Dependents ................................................................................................................. 7Cost of Coverage ............................................................................................................................. 7How to Enroll ................................................................................................................................... 8If You Do Not Enroll ......................................................................................................................... 9When Coverage Begins ................................................................................................................. 10Qualified Change in Status ............................................................................................................. 10

What Is Covered ................................................................................................................................ 12What Is Not Covered ......................................................................................................................... 15

Limitations and Exclusions ............................................................................................................. 15Other Limitations ............................................................................................................................ 15

If You Are Covered by More Than One Vision Plan ......................................................................... 16Non-Duplication of Benefits ............................................................................................................ 16Determining Primary Coverage ...................................................................................................... 16Right of Recovery .......................................................................................................................... 16

Claiming Benefits .............................................................................................................................. 18How to File Claims ......................................................................................................................... 18Where to Submit Claims ................................................................................................................. 19Appealing Claims ........................................................................................................................... 19

Additional Plan Information .............................................................................................................. 20HIPAA Special Enrollment Rights ................................................................................................... 20Qualified Medical Child Support Orders .......................................................................................... 21

If Your Situation Changes ................................................................................................................. 22When Coverage Ends ....................................................................................................................... 24

Continuing Coverage Under COBRA .............................................................................................. 24Certificate of Creditable Coverage .................................................................................................. 24

Right to Amend ................................................................................................................................. 25

The JPMorgan Chase U.S. Benefits Program is available to most employees on a U.S. payroll who areregularly scheduled to work 20 hours or more a week and who are employed by JPMorgan Chase & Co.or one of its subsidiaries to the extent that such subsidiary has adopted the JPMorgan Chase U.S.Benefits Program. This information does not include all of the details contained in the applicableinsurance contracts, plan documents, and trust agreements. If there is any discrepancy between thisinformation and the governing documents, the governing documents will control. JPMorganChase & Co. expressly reserves the right to amend, modify, reduce, change, or terminate its benefitsand plans at any time. The JPMorgan Chase U.S. Benefits Program does not create a contract orguarantee of employment between JPMorgan Chase and any individual. JPMorgan Chase or you mayterminate the employment relationship at any time.


Important TermsAs you read this summary of the JPMorgan Chase Vision Plan, you’ll come across some importantterms related to the plan. To help you better understand the plan, many of those important terms aredefined here.

Terms DefinitionBefore-TaxContributions

Contributions that are taken from your pay before federal (and, in mostcases, state and local) taxes are withheld. Before-tax dollars are alsogenerally taken from your pay before Social Security taxes are withheld.This lowers your taxable income and your income tax liability. Thisreduction to taxable income will not affect any other pay-related benefits,such as basic life insurance, long-term disability insurance, and yourRetirement Plan benefits. So, your other benefits will continue to be basedon your full, unreduced benefits pay.Keep in mind that before-tax contributions do not count as earnings forSocial Security purposes. Therefore, your future Social Security benefitcould be slightly reduced if your total earnings for the year are less thanthe Social Security wage base ($117,000 in 2014). However, this reductionis nominal and may be outweighed by the immediate tax savings resultingfrom using before-tax dollars to pay for your benefits.

Claims Administrator The company that provides certain claims administration services for theVision Plan.

Consolidated OmnibusBudget ReconciliationAct of 1985 asamended (COBRA)

A federal law that allows you and/or your covered dependents to continueVision Plan coverage on an after-tax basis (under certain circumstances)when coverage would otherwise have ended. The Plan Administrationsection of this Guide provides details on COBRA coverage.

Coordination ofBenefits

The rules that determine how benefits are paid when a person is coveredby more than one group plan. Rules include:y Which plan assumes primary liability;y The obligations of the secondary claims administrator or claims payer;

andy How the two plans ensure that the person is not reimbursed for more

than the actual charges incurred.In general, the following coordination of benefits rules apply:y As a JPMorgan Chase employee, your JPMorgan Chase coverage is

considered primary for you.y For your spouse/domestic partner or child covered as an active

employee and/or retiree of another employer, that employer’s coverageis considered primary for him or her.

y For children covered as dependents under two plans, the primary planis the plan of the parent whose birthday falls earlier in the year (basedon month and day only, not year).

Specific rules may vary, depending on whether the patient is an employeein active status (or the dependent of an employee). These rules do notapply to any private insurance you may have. Please see “If You AreCovered by More Than One Vision Plan” on page 16 for more details.

Copay or Copayment The fixed dollar amount you pay toward certain vision care services underthe Vision Plan when you receive your care from a VSP network provider.For example, when you purchase eyeglass lenses from a networkprovider, you will be required to pay a $10 copayment.


Terms DefinitionCovered Services Vision procedures that are generally reimbursable by the JPMorgan Chase

Vision Plan. While the plan provides coverage for numerous services andsupplies, there are limitations on what’s covered. For example, contactlenses are not covered under the Vision Plan in the same year you receivebenefits for eyeglass lenses. So, while a service or supply may benecessary, it may not be covered under the JPMorgan Chase Vision Plan.Please see “What Is Covered” on page 12 and “What Is Not Covered” onpage 15 for more details.

Eligible Dependents Under the Vision Plan, your eligible dependents can include your spouseor domestic partner and your children.Please see “Your Eligible Dependents” in the Medical Plan section of thisGuide for more information.

Non-Duplication ofBenefits

The Vision Plan does not allow for duplication of benefits. If you and youreligible dependents are covered under more than one group plan, theprimary plan (the one responsible for paying benefits first) needs to bedetermined. You are entitled to receive benefits up to what you would havereceived under the JPMorgan Chase Vision Plan if it were your only sourceof coverage, but not in excess of that amount. If you have other coveragethat is primary to the JPMorgan Chase Vision Plan, the claimsadministrator will reduce the amount of coverage that you would otherwisereceive under this plan by any amount you receive from your primarycoverage. Please see the definition of “Coordination of Benefits” in thissection for more information.

Qualified Change inStatus

The JPMorgan Chase benefits you elect during each annual benefitsenrollment period will generally stay in effect throughout the plan year,unless you elect otherwise due to a qualified change in status (such asmarriage, divorce, the birth or adoption of a child, etc.) within 31 days ofthe qualifying event for benefits to be effective the date of the event. If youmiss the 31-day deadline, coverage for certain benefits (i.e., medical,dental, vision, and the health care spending account) will be effective as ofthe date you contact the Benefits Call Center, and in order to haveretroactive coverage, you may be required to pay for your coverage on anafter-tax basis for the period prior to the date you first contacted theBenefits Call Center. Otherwise, you will not be able to make the change incoverage until the following annual benefits enrollment period.Please Note: Any changes you make during the year must be consistentwith your qualified change in status. Please see “Qualified Change inStatus” on page 10 for more information.

VSP VSP® Vision Care, the claims administrator for the JPMorgan ChaseVision Plan.

VSP NetworkProvider/Non-NetworkProvider

Terms referring to whether a provider is part of the network associated withthe Vision Plan (“network provider”) or is not part of the network(“non-network provider”). When a service is performed through a VSPnetwork provider, benefits are paid at a higher level than they are when aservice is performed through a non-network provider.


Some Quick FactsYour Choices The JPMorgan Chase Vision Plan lets you choose to receive eye care

from a VSP network provider or non-network provider each time youneed vision services. You will generally pay less for your eye carewhen you use a VSP network provider for two reasons:y VSP network provider eye care is generally covered at a higher

level with lower copayments than care received through anon-network provider; and

y VSP network providers have agreed to charge negotiated fees fortheir services and/or eyewear when treating JPMorgan ChaseVision Plan participants.

Coverage Categories Your coverage level is based on the dependents you enroll, as shownbelow:y Yourself only;y Yourself and your spouse/domestic partner, or Yourself and your

child(ren); ory Your family (yourself, your spouse/domestic partner, and your

children).Covered Services Covered services include all of the following:

y Eye exams;y Lenses;y Frames; andy Contact lenses.


Participating in the Vision PlanThe Vision Plan gives you access to a nationwide network of private practiceoptometrists, ophthalmologists, and optical retailers. Each time you needvision care:

y You can go to any VSP network provider — a provider who was selected byVSP and who participates in the VSP network. When you use a VSP networkprovider, you receive a higher level of benefits, and your out-of-pocketexpenses are lower.

y You can go to any non-network provider — a licensed eye care professionalwho doesn’t participate in the VSP network. When you use a provider whodoesn’t participate in the network, you receive a lower level of benefit, andyour out-of-pocket expenses are higher.

Whether you see a VSP network provider or a non-network provider, the plancovers a range of vision care services and eyewear, including eye exams, framesand lenses, contact lenses, and fittings.

Keep in mind that you always have the freedom to choose your eye care providerand the services you receive, regardless of what the plan covers or pays, butyou’re responsible for the costs not covered by the plan.

The general guidelines for participating in the JPMorgan Chase Vision Plan aredescribed in the next section.

EligibilityYour participation in the JPMorgan Chase Vision Plan is optional. In general, youare eligible to participate if you are:

y On a U.S. payroll of your employer and you are subject to FICA taxes;

y Paid salary, draw, commissions, or production overrides;

y Regularly scheduled to work 20 or more hours per week; and

y Employed by JPMorgan Chase & Co. or one of its subsidiaries to the extentthat such subsidiary has adopted the plan.

Please Note: An individual classified or employed in a work status other than asa common law salaried employee by his/her employer, such as an:

y Independent contractor/agent (or its employee);

y Hourly-paid employee;

y Intern; and/or

y Occasional/seasonal, leased, or temporary employee

is not eligible to participate in the plan regardless of whether an administrative orjudicial proceeding subsequently determines this individual to have instead beena common law salaried employee.


Coverage CategoriesWhen you enroll in the Vision Plan, your coverage level is based on thedependents you enroll and includes the following coverage categories:

y Employee only;

y Employee plus spouse/domestic partner or Employee plus child(ren); and

y Family (employee plus spouse/domestic partner plus child(ren)).

Your Eligible DependentsIn addition to covering yourself under the Vision Plan, you can also cover youreligible dependents. For details about your eligible dependents, please see “YourEligible Dependents” in the Medical Plan section of this Guide.

Cost of CoverageYou pay the entire cost for vision coverage with before-tax contributions. Yourcost for coverage depends on the number and type of dependents you cover.Your contributions toward the cost of coverage start when your coverage begins.(Please see “When Coverage Begins” on page 10 for more information.) Yourcontributions are automatically deducted from your pay in equal installments(unless retroactive payments are required).

If you have coverage but are away from work because of an unpaid sickness orleave of absence, you will be directly billed by JPMorgan Chase for any requiredcontributions on an after-tax basis.

Tax Treatment of Domestic PartnerCoverage/Gross-Up PolicyIf you cover a domestic partner there are tax implications of which you should beaware. JPMorgan Chase is required to report the entire value of the visioncoverage for a “Domestic Partner” as taxable (or “imputed”) income to you and towithhold for federal, state, and FICA taxes on the imputed income.

To offset the additional federal and state tax that is payable in order to cover adomestic partner, employees who cover same-sex domestic partners receivespecial “gross up” pay to compensate for the cost of the additional taxes. You willreceive recurring payments, each of which represents an offset for federal(including FICA) and state taxes, if applicable, that you paid on benefits in theprior pay period. You can identify these payments on your pay statement underEarnings, “Benefit Tax Offset – GUDP.”

Because these payments will be taxable payments, the payments include anadditional amount to help adjust for the taxes that you will pay on the paymentsthemselves. They are based on estimated federal (25%) and state tax rates andinclude a FICA adjustment for individuals whose wages do not exceed the FICAwage limit for the prior year.

Please Note: If you certify that your domestic partner and/or your domesticpartner’s children are your tax dependents, you will not receive the benefit taxoffset payment described above, as you will not be subject to taxation of imputedincome on the tax dependent’s coverage.

An Important Note onDependent Coverage

If JPMorgan Chaseemploys your spouse,domestic partner, orchild, he or she can becovered as an employeeor as your dependent,but not as both. If youwant to cover youreligible children, you oryour spouse/domesticpartner (but not both ofyou) can choose toprovide this coverage.

Enrolling a DomesticPartner

Additional informationabout enrolling and thetax consequences ofcovering a domesticpartner can be found onMy Health.


How to EnrollParticipation in the Vision Plan is optional.

If You: What You Need to Do to Enroll:Are an Employee During an annual benefits enrollment period, you can make

your election through the Benefits Web Center on My Healthor through the Benefits Call Center. At the beginning of eachenrollment period, you’ll receive instructions on how to enroll.To access the Benefits Web Center, go to My Health > OtherBenefits > Benefits Web Center.You’ll also receive information about the option available toyou and its costs at that time. You need to consider yourchoice carefully; you can’t change your enrollment decisionduring the year unless you have a qualified change in status.Please see “Qualified Change in Status” on page 10 for moreinformation.

Are a Newly Hired Employee If you’ve just joined JPMorgan Chase and are enrolling for thefirst time, you need to make your choices through the BenefitsWeb Center on My Health or through the Benefits Call Centerwithin 31 days of your date of hire if you are a full-timeemployee, and within 31 days prior to becoming eligible if youare a part-time employee, as explained below:If you are a full-time employee, you may receive informationregarding benefits enrollment after accepting a position withJPMorgan Chase but before your hire date. Your coverage willbegin on the first of the month following your hire date, as longas you enroll prior to your hire date or within 31 days after yourhire date.If you are a part-time employee, you will receive yourenrollment materials within 31 days before becoming eligiblefor coverage. You need to enroll within 31 days before youreligibility date.You can access your benefits enrollment materials online atMy Health > New hire benefits enrollment. To access theBenefits Web Center, go to My Health > Other Benefits >Benefits Web Center.

Have a Change in Work Status orQualified Change in Status

If you’re enrolling during the year because you’re a newlyeligible employee due to a work status change or you have aqualified change in status, you’ll have 31 days from the date ofthe change in status (including the birth or adoption of a child,etc.) to make your new choices through the Benefits WebCenter on My Health or through the Benefits Call Center. Toaccess the Benefits Web Center, go to My Health > OtherBenefits > Benefits Web Center. Please see “Qualified Changein Status” on page 10 for more information.


If You Do Not EnrollIf You: What Happens If You Do Not Enroll:Are an Employee If you’re already participating in the Vision Plan and do not

cancel coverage during the annual benefits enrollment period,you’ll generally keep the same coverage for the following planyear that you had before the annual benefits enrollmentperiod (if available) or you will be assigned coverage byJPMorgan Chase. However, you’ll be subject to any changesin the plan and coverage costs.

Are a Newly Hired or NewlyEligible Employee

If you’re a new hire or newly eligible employee and do notenroll before the end of the designated 31-day enrollmentperiod, coverage for certain benefits will be effective as of thedate you contact the Benefits Call Center, and in order tohave retroactive coverage, you may be required to pay foryour coverage on an after-tax basis for the period prior to thedate you first contact the Benefits Call Center. Otherwise, youwill not be able to make the change in coverage until thefollowing annual benefits enrollment period. Please see“Qualified Change in Status” on page 10 for more information.

Have a Qualified Change in Status If you have a qualified change in status that allows you toenroll in the Vision Plan mid-year and you do not enroll withinthe designated 31-day eligibility period, coverage for certainbenefits will be effective as of the date you contact theBenefits Call Center and, in order to have retroactivecoverage, you may be required to pay for your coverage onan after-tax basis for the period prior to the date you firstcontact the Benefits Call Center. Otherwise, you will not beable to make the change in coverage until the followingannual benefits enrollment period. Please see “QualifiedChange in Status” on page 10 for more information.


When Coverage BeginsIf You: When the Coverage You Elect Begins:Are an Employee The coverage you elect during the annual benefits enrollment period

takes effect the beginning of the following plan year (January 1).Are a Newly Hired orNewly Eligible Employee

The coverage you elect as a new hire takes effect as follows:y If you are a full-time employee, coverage begins on the first of the

month following your date of hire.y If you are a part-time employee regularly scheduled to work at least

20 but less than 40 hours per week, coverage begins the first of themonth following 60 days from your date of hire.

Have a Change in WorkStatus or QualifiedChange in Status

The coverage you elect as a result of a qualifying event (such asmarriage, divorce, or the birth or adoption of a child or a work-relatedevent such as an adjustment to your regularly scheduled work hoursthat results in a change in eligibility) will take effect as of the day of thequalifying event, if you enroll within 31 days of the event and you havealready met the plan’s eligibility requirements. If you miss the 31-daydeadline, coverage for certain benefits will be effective as of the dateyou contact the Benefits Call Center and, in order to have retroactivecoverage, you may be required to pay for your coverage on an after-taxbasis for the period prior to the date you first contact the Benefits CallCenter. Otherwise, you will not be able to make the change in coverageuntil the following annual benefits enrollment period. Please see“Qualified Change in Status” below for more information.

Qualified Change in StatusThe Vision Plan elections you make during the annual benefits enrollment period will stay in effectthrough the following plan year (or the current plan year if you enroll during the year as a newly eligibleemployee). However, you may be permitted to change your elections before the next annual benefitsenrollment period if you have a qualified change in status. Please Note: Any changes you make duringthe year must be consistent with your qualified change in status.

If you have a qualified change in status and want to change your elections, please see the BenefitsStatus Change Guide, which includes details on how to make changes. The Guide is available on MyHealth > Benefits updates for new situations and is also available on request through the BenefitsCall Center.

You need to enroll through the Benefits Web Center on My Health or through the Benefits Call Centerwithin 31 days of the qualifying event for benefits to be effective on the date of the event. To access theBenefits Web Center, go to My Health > Other Benefits > Benefits Web Center. If you miss the 31-daydeadline, coverage for certain benefits (i.e. medical, dental, vision and health care spending account)will be effective as of the date you contact the Benefits Call Center and, in order to have retroactivecoverage, you may be required to pay for your coverage on an after-tax basis for the period prior to thedate you first contact the Benefits Call Center. Otherwise, you will not be able to make the change incoverage until the following annual benefits enrollment period. Your deadline to report a qualifying eventmay be extended to 60 days if your newly eligible dependent dies prior to adding them to coverage.Please contact the Benefits Call Center if this situation applies to you.


Please Note: Documentation of dependent eligibility will be required when adding a dependent forcoverage and may be requested at any time by JPMorgan Chase or the claims administrator.JPMorgan Chase regularly conducts dependent eligibility verification to ensure that all covereddependents meet the current eligibility requirements of the JPMorgan Chase U.S. Benefits Program. Fordetails, please see an “Important Note on Dependent Eligibility” in the Medical Plan section ofthis Guide.

If you have questions during the year about qualifying events and what the allowed benefit changes are,please visit the Benefits Web Center on My Health or contact the Benefits Call Center and speak with aService Representative. To access the Benefits Web Center, go to My Health > Other Benefits >Benefits Web Center.

Qualified changes in status for eligible dependents under the Vision Plan are listed in thefollowing table.

Vision Plan Changes for Qualified Change in StatusEvent Vision Plan ChangesYou get married Add coverage for yourself and/or your eligible

dependentsYou enter into a domestic partner relationship or civilunion

Add coverage for yourself, your domesticpartner, and any eligible children

You have, adopt, or obtain legal guardianship of achild*

Add coverage for yourself and/or your eligibledependents

You and/or your covered dependents gain otherbenefits coverage*

Cancel coverage for yourself and/or yourcovered dependents who have gained othercoverage

You and/or your eligible dependents lose otherbenefits coverage*

Add coverage for yourself and/or your eligibledependents who have lost other coverage

You get legally separated or divorced Cancel coverage for your former spouse and/orchildren who are no longer eligible

You end a domestic partner relationship or civilunion

Cancel coverage for your domestic partner andyour domestic partner’s eligible children

A child is no longer eligible for coverage* Cancel coverage for your childA covered family member dies* Cancel coverage for your deceased dependent

and any children who are no longer eligible* Also applies to a domestic partner relationship.


What Is CoveredThe Vision Plan covers a variety of services. The way benefits are paid depends on whether youreceive your eye care from a VSP network provider or a non-network provider. Please Note: Sinceroutine eye exams are not covered under the JPMorgan Chase Medical Plan options, you will need toenroll in the Vision Plan to be covered for routine vision benefits.

Selecting a VSP Network ProviderIf you decide to enroll in the Vision Plan and want to use a VSP network provider, you can choose adifferent provider for yourself and for each covered dependent. VSP network providers include doctorsand retail chain affiliates such as Costco, Wisconsin Vision, Heartland Vision, Rx Optical, and certainCohen’s Fashion Optical locations.

You can easily check which providers participate in the VSP network by using the Enrollment DecisionToolkit via the Benefits Web Center via My Health or by accessing the Vision Plan option’s website (ifyou are enrolled in the Vision Plan). To access the Vision Plan option’s website, go to the Benefits WebCenter on My Health. Go to My Health > Other Benefits > Benefits Web Center.

You may also request a provider directory directly from VSP. For contact information, please see“The Vision Plan” on page 1.

How the Vision Plan Pays BenefitsCare and Service* In-Network

AllowanceNon-NetworkAllowance

WellVision Exam® **(A complete initial vision analysis, which includesa comprehensive visual exam, including theprescription for corrective eyewear, if necessary)

100% Reimbursed up to $45

Retinal Screening, an enhancement to theWellVision Exam®

Up to $39 copayment No coverage

Lenses**Single vision lenses** (Lenses having one partthat corrects for either near vision or distantvision)

100% after $10copayment

Reimbursed up to $30

Lined bifocal lenses** (Lined lenses having onepart that corrects for near vision, one for distantvision)



Lined trifocal lenses** (Lined lenses having onepart that corrects for near vision, one forintermediate vision, and one for distant vision)



Lens options**y Standard progressive lenses $55 Reimbursed up to $50y Premium progressive lenses $95-$105 Reimbursed up to $50y Custom progressive lenses $150-$175 Reimbursed up to $50y Standard Polycarbonate lenses Fully covered without a

copaymentNo coverage

* Coverage through in-network retail chains may be different and is subject to change. Consult the Vision Plan option’s websitevia the Benefits Web Center on My Health. Go to My Health > Other Benefits > Benefits Web Center.

** Limited to once per calendar year per covered individual.


Care and Service* In-NetworkAllowance

Non-NetworkAllowance

y Tints (Solid or Gradient) Fully covered without acopayment

Reimbursed up to $5

y Standard Scratch Coating Fully covered without acopayment

No coverage

y UV Coating $16 copayment No coveragey Standard anti-reflective coating $41 copayment No coveragey Premium anti-reflective coating $58-$85 copayment No coverageFrames** For frame purchased

an in-network retailchains***: $150allowance after $10copayment; plus 20%discount off amount overthe allowanceFor frames purchasedat Costco, regardlessof frame brand: $80allowance after $10copayment; plus 20%discount off amount overthe allowance


Contact lenses**Please Note: If you choose contacts, you won’t be eligible to receive eyeglass lenses and frames as acovered benefit during the same calendar year.y Contact lens exam (fitting and evaluation) y Copayment of up to

$55Reimbursed up to$105

y Contact lens y $150 allowance

Other Servicesy Laser vision correction 15% off retail price or 5%

off promotional pricesNot covered

* Coverage through in-network retail chains may be different and is subject to change. Consult the Vision Plan option’s websitevia the Benefits Web Center on My Health. Go to My Health > Other Benefits > Benefits Web Center.

** Limited to once per calendar year per covered individual.

*** In-network retail chains, which are subject to change, include but are not limited to Costco, Wisconsin Vision, HeartlandVision, Rx Optical, and certain Cohen’s Fashion Optical locations.

Additional pairs of prescription glasses and sunglasses (lenses and frames) are available at a 20%discount within 12 months of your last WellVision exam.


Low Vision Benefits

When you visit a VSP network provider, the plan may provide certain benefits if you have severe visionproblems that are not correctable with regular lenses. To receive benefits, your provider must completeand submit a Low Vision Authorization Form to VSP.

The following chart shows how the Vision Plan pays benefits for low vision (in-network only):

Care and Service Benefits PaidLow vision aids approved by the claimsadministrator

75%, up to a $1,000 maximum every two years*Supplementary testing approved by the claimsadministrator (a complete low vision analysis anddiagnosis which provides a comprehensive visionexam, including prescription corrective eyewearor other vision aids)

* You are responsible for paying 25% of the cost for approved low vision aids in addition to any amount over the maximum.


What Is Not CoveredWhile the JPMorgan Chase Vision Plan covers a variety of vision expenses, the expenses listed beloware not covered. This list of excluded expenses may change at any time.

y Any costs that exceed the allowance;

y Special lens coatings or laminations; and

y Special or designer frames or oversized lenses.

Limitations and Exclusionsy Orthoptic or vision training, subnormal vision aids, and any associated supplemental testing;

y Aniseikonic lenses;

y Medical and/or surgical treatment of the eye, eyes, or supporting structures*;

y Any eye or vision examination, or any corrective eyewear required by an employer as a condition ofemployment, and safety eyewear unless specifically covered under the plan;

y Services provided as a result of any workers’ compensation law;

y Non-prescription lenses and non-prescription sunglasses (except for 20% discount);

y Two pairs of glasses in lieu of bifocals;

y Certain frames in which the manufacturer imposes a no discount policy; and

y Lost or broken lenses, frames, glasses or contact lenses will not be replaced except in the next planyear, when vision benefits would again become available

Other LimitationsIf you choose contact lenses, you will not be eligible to receive prescription lenses as a covered benefitduring the same calendar year. Benefits paid are subject to certain limitations and maximums set by theclaims administrator. You are responsible for paying the cost of any optional items or services notcovered by the Vision Plan. You are also responsible for payment of any applicable sales tax.* Please Note: These expenses may be covered by the JPMorgan Chase Medical Plan. Refer to the Medical Plan section of

this Guide for additional information.


If You Are Covered by More ThanOne Vision PlanThe JPMorgan Chase Vision Plan has a provision to ensure that payments from all of your group visionplans don’t exceed the amount the JPMorgan Chase Vision Plan would pay if it were your onlycoverage. The following rules do not apply to any private, personal insurance you may have.

Non-Duplication of BenefitsThe JPMorgan Chase Vision Plan does not allow for duplication of benefits. If you and your eligibledependents are covered under more than one group plan, the primary plan (the one responsible forpaying benefits first) needs to be determined. The non-duplication provisions of the Vision Plan willensure that, in total, you receive benefits up to what you would have received with the JPMorgan ChaseVision Plan as your only source of coverage (but not in excess of that amount), based on the primarycarrier’s allowable amount. A summary of coordination rules (i.e., how JPMorgan Chase coordinatescoverage with another group plan to ensure non-duplication of benefits) is provided below. If you havequestions, please contact your claims administrator for help. For contact information, please “Where toSubmit Claims” on page 19.

Determining Primary CoverageTo determine which vision plan pays first as the primary plan, here are some general guidelines:

y As an active JPMorgan Chase employee, the Vision Plan will be primary for you and consider claimsfor your vision expenses first.

y If your covered dependent has a claim, the plan covering your dependent as an employee will beconsidered primary to this plan.

y If your claim is for a covered child, the plan covering the parent who has the earlier birthday in acalendar year (based on month and birthday only) will be considered primary. In the event of divorceor legal separation, and in the absence of a qualified medical child support order, the plan coveringthe parent with court-decreed financial responsibility will be considered primary for the covered child.If there is no court decree, the plan of the parent who has custody of the covered child will beconsidered primary for the covered child. (Please see “Qualified Medical Child Support Orders” onpage 21 for more information.)

y If your other vision plan doesn’t have a coordination of benefits provision, that plan will be consideredprimary and will pay first for you and your covered dependents.

y If payment responsibilities are still unresolved, the plan that has covered the claimant the longestpays first.

After it’s determined which plan is primary, you’ll need to submit your initial claim to that plan.

After the primary plan pays benefits (up to the limits of its coverage), you can then submit the claim tothe other plan (the secondary plan) to consider your claim for any unpaid amounts. You’ll need toinclude a copy of the written Explanation of Benefits (EOB) from your primary plan.

Right of RecoveryIf the Vision Plan provides benefits to you or a covered dependent that are later determined to be thelegal responsibility of another person or company, the Vision Plan has the right to recover thesepayments from you or from the person or company who is determined to be legally responsible.Assignment of your claim to a third party does not exempt you from your responsibility for repaying theplan. You must notify the plan promptly of any circumstance in which a third party may be responsiblefor compensating you with respect to an illness or injury that results in the plan making payments onyour behalf.


Subrogation of BenefitsThe purpose of the Vision Plan is to provide benefits for eligible vision expenses that are not theresponsibility of any third party. The Vision Plan has the right to recover from any third party responsiblefor compensating you with respect to an illness or injury that results in the plan making payments onyour behalf or on behalf of a covered dependent. This is known as subrogation of benefits. Thefollowing rules apply to the plan’s subrogation of benefits rights:

y The plan has first priority from any amounts recovered from a third party for the full amount ofbenefits it has paid on your behalf regardless of whether you are fully compensated by the third partyfor your losses.

y You agree to help the plan use this right when requested.

y In the event that you fail to help the plan use this right when requested, the plan may deduct theamount the plan paid from any future benefits payable under the plan.

y The plan has the right to take whatever legal action it deems appropriate against any third party torecover the benefits paid under the plan.

y If the amount you receive as a recovery from a third party is insufficient to satisfy the plan’ssubrogation claim in full, the plan’s subrogation claim shall be first satisfied before any part of arecovery is applied to your claim against the third party.

y The plan is not responsible for any attorney fees, attorney liens, or other expenses you may incurwithout the plan’s prior written consent. The “common fund” doctrine does not apply to any amountrecovered by any attorney you retain regardless of whether the funds recovered are used to repaybenefits paid by the plan.

Right of ReimbursementIn addition to its subrogation rights, the Vision Plan is entitled to reimbursements from a covered personwho receives compensation from any third parties (other than family members) for vision expenses thathave been paid by the Vision Plan. The following rules apply to the plan’s right of reimbursement:

y You must reimburse the plan in first priority from any recovery from a third party for the full amount ofthe benefits the plan paid on your behalf, regardless of whether you are fully compensated by thethird party for your losses.

y Regardless of any allocation or designation of your recovery made in a settlement agreement orcourt order, the plan shall have a right of full reimbursement, in first priority, from the recovery.

y You must hold in trust for the benefit of the plan the gross proceeds of a recovery, to be paid to theplan immediately upon your receipt of the recovery. You must reimburse the plan, in first priority andwithout any set-off or reduction for attorney fees or other expenses. The “common fund” doctrinedoes not apply to any funds recovered by any attorney you retain regardless of whether the fundsrecovered are used to repay benefits paid by the plan.

y If you fail to reimburse the plan, the plan may deduct any unsatisfied portion of the amount ofbenefits the plan has paid or the amount of your recovery from a third party, whichever is less, fromfuture benefits payable under the plan.

y If you fail to disclose the amount of your recovery from a third party to the plan, the plan shall beentitled to deduct the full amount of the benefits the plan paid on your behalf from any future benefitspayable under the plan.


Claiming BenefitsThe following explains when and how to file claims for vision expenses. For more information on yourrights with respect to claims, please see the Plan Administration section of this Guide.

How to File ClaimsRules regarding claims depend on whether you receive your eye care from a VSP network provider or anon-network provider, as shown below:

VSP Network ProviderBenefits

You will generally not need to submit a claim form to be entitled tobenefits. Your VSP provider will submit claims on your behalf. You’llgenerally need to pay the copayment and any non-covered expenses atthe time you receive services.

Out-of-NetworkProvider Benefits

You or the out-of-network provider must file a claim form. Claim forms areavailable on My Health. Go to: My Health > Benefits, Health & WellnessResources > Claim forms. You can receive reimbursement up to specificdollar amounts for annual exams and eyewear if you use a non-networkprovider. You first pay the provider the full cost for services renderedand/or eyewear purchased, and then submit a claim form to VSP. Pleasesee “Where to Submit Claims” on page 19 for your claim administrator’sphone and address information.

To have your claim considered for benefits, you need to file your claim by December 31 of the yearfollowing the year in which the services were provided. If you fail to meet this deadline, your claim will bedenied. Be sure to attach itemized bills or receipts to your claim form, and keep copies for your records.

Your claim must include your receipts showing:

y An itemized listing of the services received;

y The non-network provider’s name, address, and phone number;

y The covered member’s name, address, and phone number;

y The covered member’s Social Security number;

y The group name (JPMorgan Chase);

y The patient’s name, date of birth, address, and phone number; and

y The patient’s relationship to the covered member (such as self, spouse, child, etc.).

Separate claim forms must be submitted for each family member for whom a claim is made. After yousubmit a claim, you will receive a written explanation of how the benefit was paid.


Where to Submit ClaimsThe claims administrator’s contact information for the Vision Plan is listed in the following table:

Claims Administrator’s Contact InformationClaims Administrator Address and Telephone NumberVSP® Vision Care VSP

P.O. Box 997105Sacramento, CA 95899-71051-855-846-72318 a.m. to 11 p.m. Eastern Time, Monday throughFriday; 10 a.m. to 10 p.m. Eastern Time, Saturdayand Sunday

Appealing ClaimsIf a claim for reimbursement under the Vision Plan is denied, either in whole or in part, you can appealthe denial by following the appropriate procedures described in the Plan Administration section ofthis Guide.


Additional Plan InformationYour primary contact for all matters relating to Vision Plan benefits is your claims administrator (see“Claims Administrator’s Contact Information” on page 19). Contact the Benefits Call Center forinformation about general administration issues such as enrollment and eligibility for the Plan.

Your benefits as a participant in the Vision Plan are provided under the terms of this document andinsurance contracts, if any, issued to JPMorgan Chase. If there is a discrepancy between the insurancecontracts and this document, the insurance contracts will control. Please Note: No person or group,other than the Plan Administrator for the JPMorgan Chase U.S. Benefits Program, has any authority tointerpret the Vision Plan (or official plan documents) or to make any promises to you about them. ThePlan Administrator for the JPMorgan Chase U.S. Benefits Program has complete authority in his or hersole and absolute discretion to construe and interpret the terms of the Vision Plan and any underlyinginsurance policies and/or contracts, including the eligibility to participate in the Vision Plan. All decisionsof the Plan Administrator for the JPMorgan Chase Benefits Program are final and binding upon allaffected parties.

HIPAA Special Enrollment RightsThe Health Insurance Portability and Accountability Act (HIPAA) is a federal law that provides specialenrollment rights to employees and eligible dependents who decline coverage under the Vision Planbecause they have vision coverage through another source — and then lose that coverage. Theserights also apply if you acquire an eligible dependent.

If you or your eligible dependent declined coverage under the Vision Plan, you may enroll for visioncoverage within 31 days of one of the following events for coverage to be effective the date of the event.If you miss the 31-day deadline, coverage for certain benefits will be effective as of the date you contactthe Benefits Call Center and, in order to have retroactive coverage, you may be required to pay for yourcoverage on an after-tax basis for the period prior to the date you first contact the Benefits Call Center.Otherwise, you will not be able to make the change in coverage until the following annual benefitsenrollment period.

y You and/or your eligible dependents lose other group vision coverage because you no longer meetthe eligibility requirements (due to legal separation, divorce, death, termination of employment, orreduced work hours);

y If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, youmay be able to enroll yourself and your dependents, provided that you request enrollment within 31days after the marriage, birth, adoption, or placement for adoption. If you are eligible for coverage,but do not enroll, your dependent cannot enroll;

y Employer contributions for the other coverage ends; or

y The other coverage was provided under the Consolidated Omnibus Budget Reconciliation Act(COBRA) and the COBRA coverage period ends.

If you qualify for this HIPAA special enrollment, your coverage under the Vision Plan will begin on thedate of the event provided you enroll within the appropriate timeframe and pay the requiredcontributions.

Effective April 1, 2009, if you or your eligible dependent loses Medicaid or Children’s Health InsuranceProgram (CHIP) coverage because you are no longer eligible, or become eligible for a premiumassistance subsidy under Medicaid or CHIP, you may enroll for JPMorgan Chase coverage, as long asyou make your request within 60 days of the event.


HIPAA Privacy Rights and Protected Health InformationJPMorgan Chase is committed to maintaining the highest level of privacy and discretion regarding yourpersonal compensation and benefits information. The Health Insurance Portability and AccountabilityAct (HIPAA) legally requires employers — like JPMorgan Chase — to specifically communicate howcertain “protected health information” under employee health care plans may be used and disclosed, aswell as how plan participants can get access to their protected health information.

JPMorgan Chase may only use and disclose protected health information received from the Vision Planclaims administrator in ways that are permitted by, required by, and consistent with HIPAA privacyregulations.

For details about HIPAA privacy regulations and your rights with regard to this information, please see“HIPAA Privacy Rights and Protected Health Information” in the Medical Plan section of this Guide.

Qualified Medical Child Support OrdersIf the Vision Plan receives a judgment, decree, or order known as a Qualified Medical Child SupportOrder (QMCSO) requiring the plan to provide health coverage to your child or foster child who is yourdependent, the Vision Plan will automatically change your benefits elections to provide coverage for thechild. In the case of a child whom you are required to cover pursuant to a QMCSO, coverage will beginon the date the QMCSO is processed by JPMorgan Chase. You may decrease your coverage for thatchild, if the court order requires the child’s other parent to provide coverage and your spouse’s or formerspouse’s plan actually provides that coverage. You also may make other corresponding changes toyour benefits elections under the Vision Plan, to the extent permitted by the Internal Revenue Code(IRC) and the Vision Plan.


If Your Situation ChangesThe following chart summarizes how your JPMorgan Chase Vision Plan coverage may be affected incertain situations.

If Your WorkStatus Changes

Your Vision Plan coverage will end on the last day of the month in which yourwork status changes and you are then scheduled to work fewer than 20hours per week. Even if your coverage ends, however, you may be able tocontinue vision coverage for a certain period of time under the ConsolidatedOmnibus Budget Reconciliation Act of 1985 as amended (COBRA). (Pleasesee the Plan Administration section of this Guide for more information onCOBRA.)

If You Go onDisability Leave

Under the Short-Term Disability Plan, you may have the financial protectionof full or partial pay for up to 25 weeks. For the approved period of yourdisability leave, you’ll remain eligible to be covered under the Vision Plan.JPMorgan Chase will deduct any required contributions for vision coveragefrom the pay you receive during this period on a before-tax basis.

If You Go onLong-TermDisability

If you receive long-term disability (LTD) benefits from the LTD Plan, yourpremium will be converted to a monthly rate. (The actual cost of yourcoverage will not change; however, you will be required to pay for thiscoverage monthly on an after-tax basis.) You will pay for this coverage on adirect-bill basis with JPMorgan Chase.If you become disabled on or after January 1, 2011, you’ll be eligible tocontinue your vision coverage at active employee rates for the first 24months after going on approved LTD (i.e. 30 months from the date ofdisability).Please Note: Your employment with JPMorgan Chase will end immediatelyafter you have received 24 months of payments under the LTD Plan. You willcontinue to be eligible for LTD benefits provided you meet all contractualprovisions outlined in the plan. (Please see the Long-Term Disability sectionof this Guide for more information.)If you became disabled before January 1, 2011, your vision coverage willcontinue at active employee rates while you receive benefits under theLong-Term Disability Plan.Even if your coverage ends, however, you may be able to continue visioncoverage for a certain period of time under the Consolidated OmnibusBudget Reconciliation Act of 1985 as amended (COBRA). (Please see thePlan Administration section of this Guide for more information on COBRA.)

If You Go on anUnpaid Leave

For an approved leave of absence, you’ll still be covered by the Vision Planas long as you make any required contributions. JPMorgan Chase willdirectly bill you for any required contributions on an after-tax basis.If you do not make the required contributions to continue your Vision Plancoverage, your coverage will be canceled. However, your coverage may beautomatically reinstated when you return to work.Please see the Plan Administration section of this Guide for more informationabout what happens to your benefits during an unpaid leave of absence (i.e.,FMLA, Military Leave).


If You LeaveJPMorgan Chase

If your employment with JPMorgan Chase terminates, participation for youand your covered dependents usually ends on the last day of the month inwhich you end active employment. However, you generally will be eligible tocontinue Vision Plan participation for a certain period of time under COBRA.(Please see the Plan Administration section of this Guide for moreinformation on COBRA.) Vision expenses incurred after the end of the monthin which you leave JPMorgan Chase cannot be reimbursed by the VisionPlan unless you choose to continue your participation under COBRA. Formore information, please see the As You Leave Guide on me@jpmc >Health & Life > Life Events > Leaving the Company.

If You Retire fromJPMorgan Chase

You may enroll for retiree vision coverage even if you were not coveredunder the Vision Plan at the time of your retirement. For more information,please refer to the As You Retire Guide on me@jpmc > Health & Life > LifeEvents > Retiring.

If You Work PastAge 65

If you continue to work for JPMorgan Chase after you reach age 65 (and/or ifyour spouse/domestic partner reaches age 65 while you’re still working atJPMorgan Chase), you and your spouse/domestic partner can continue to becovered under the Vision Plan.

If You Divorce orBecome LegallySeparated

If your spouse and/or children lose coverage as a result ofdivorce/separation, they may have a right to elect COBRA for up to 36months. (Please see the Plan Administration section of this Guide for moreinformation.)If you divorce or become legally separated, certain court orders could requireyou to provide vision benefits to covered children. JPMorgan Chase is legallyrequired to recognize qualified medical child support orders within the limitsof the Vision Plan. If you’re a party in a divorce settlement that involves theVision Plan, you should have your attorney contact the Benefits Call Centerto make sure the appropriate documents are filed and that the court order inquestion is actually a qualified medical child support order that complies withgoverning legislation. Please see “Qualified Medical Child Support Orders”on page 21 for more information.

If You Die If you die while actively employed at JPMorgan Chase, any dependents whowere covered under your Vision Plan before your death will continue to becovered until the last day of the month in which you die. Covered dependentscan then elect to continue coverage under COBRA and pay the activeemployee rate for coverage for up to 36 months of the COBRA period.Dependents must be covered under the Vision Plan at the time of your deathto be eligible for COBRA coverage. (Please see the Plan Administrationsection of this Guide for more information on COBRA.)In addition, any dependents who were enrolled in the Vision Plan at the timeof your death may be eligible to continue coverage under the Vision Plan if,at the time of death:y You have already met the general eligibility requirements for retirement

(For more information, please refer to the As You Retire Guide, availableon me@jpmc > Health & Life > Life Events > Retiring.); or

y You have already met the alternative eligibility requirements for retirementin the event of a position elimination. (For more information, please referto the As You Retire Guide, as noted above.); or

y You have 25 years of total service with JPMorgan Chase.Dependents may continue coverage under the Vision Plan as long as theymeet the Vision Plan’s requirements.


When Coverage EndsCoverage under the JPMorgan Chase Vision Plan option will end on the last day of the month in which:

y You cancel coverage due to a qualified change in status;

y You stop making required contributions;

y Your employment with JPMorgan Chase is terminated for any reason;

y You no longer meet the eligibility requirements of the Vision Plan;

y The Vision Plan is discontinued;

y You have been on long-term disability benefits under the Long-Term Disability Plan for 24 months,unless you were disabled prior to January 1, 2011, in which case your coverage will continue atactive employee rates while you receive benefits under the Long-Term Disability Plan; or

y You die.

Coverage for your dependents ends when they no longer meet the eligibility requirements described in“Your Eligible Dependents” in the Medical Plan section of this Guide. For your spouse, this means thelast day of the month in which you die (unless you are eligible for retiree medical coverage) or divorce.For a child, this means the last day of the month in which he or she:

y Turns age 26. Please see “Your Eligible Dependents” on page 7 for more information; or

y Is no longer eligible for coverage under a Qualified Medical Child Support Order (QMCSO).

Coverage for a domestic partner ends on last day of the month in which the domestic partner ceases tomeet the eligibility requirements described in “Your Eligible Dependents” in the Medical Plan section ofthis Guide.

Please see “If Your Situation Changes” on page 22 for details on how coverage is affected in certainsituations.

Continuing Coverage Under COBRAUnder the Consolidated Omnibus Budget Reconciliation Act of 1985 as amended (COBRA), you andyour covered dependents have the right to continue vision coverage at your own expense for a certainperiod of time if your JPMorgan Chase-provided coverage ends due to certain circumstances. (Fordomestic partners, JPMorgan Chase may provide COBRA-like coverage if the domestic partner wascovered under the JPMorgan Chase Vision Plan at the time that coverage ended.) If continuationcoverage is elected, the cost is typically 102% of the plan’s total cost of providing coverage for up to 18months. You must make timely monthly payments for your COBRA coverage. Please see the PlanAdministration section of this Guide for more information on COBRA.

Certificate of Creditable CoverageUnder the Health Insurance Portability and Accountability Act of 1996 (HIPAA), JPMorgan Chase isrequired to provide you with a Certificate of Creditable Coverage if your JPMorgan Chase-providedcoverage ends. For more information, please see “Certificate of Creditable Coverage” in the PlanAdministration section of this Guide.


Right to AmendJPMorgan Chase reserves the right to amend, modify (including cost of coverage), reduce or curtailbenefits under, or terminate the Vision Plan at any time for any reason by act of the Benefits Executive,other authorized officers, or the Board of Directors. In addition, the Vision Plan does not represent avested benefit.

JPMorgan Chase also reserves the right to amend any of the plans and policies, to change the methodof providing benefits, to curtail or reduce future benefits, or to terminate at any time for any reason, anyor all of the plans and policies described in this Guide. Neither this Guide nor the benefits described inthis Guide create a contract or a guarantee of employment between JPMorgan Chase and anyemployee.

If you have any questions about this plan, contact the Benefits Call Center.

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