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Barnstable County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans		 Product Name Form Number
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 		 NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
United HealthCare Insurance Company Group Vision Care
 		 VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Berkshire County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company Aetna Vision Preferred GR-9 et al.
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage C-9059MA (12/08)
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Access
 		 C-9083MA
 

Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Insight C-9083MA
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Select
 		 C-9083MA
 

Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Access C-9093MA
 

Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Insight C-9093MA
 

Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Select C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 		 NVIGRP 5/07-MA
 
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
United HealthCare Insurance Company Group Vision Care
 		 VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Bristol County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company Aetna Vision Preferred
 		 GR-9 et al.
 
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 		 C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 		 C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 		 C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 		 C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 		 NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Starmount Life Insurance Company Group Vision Care Insurance VI-2007CT-MA
Starmount Life Insurance Company Group Vision w/Insight Network VI-2007CT-MA-EM
United HealthCare Insurance Company Group Vision Care
 		 VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Dukes County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans		 Product Name Form Number
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
National Guardian Life Insurance Company Superior Vision Plan NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA
Group Vision PPO Plan		 C22439DBG-MA
Principal Life Insurance Company Group Vision Expense GC 9000
Union Security Insurance Company Group Vision Certificate w/VSP Form GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Essex County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company
 		 Aetna Vision Preferred
 		 GR-9 et al.
 
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan  VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Access
 		 C-9083MA
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Advantage
 		 C-9083MA
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Insight
 		 C-9083MA
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Select
 		 C-9083MA
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Access
 		 C-9093MA
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Advantage
 		 C-9093MA
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Insight
 		 C-9093MA
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Select
 		 C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 		 NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Standard Insurance Company  Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Starmount Life Insurance Company Group Vision Care Insurance VI-2007CT-MA
Starmount Life Insurance Company
Group Vision w/Insight Network
VI-2007CT-MA-EM
United HealthCare Insurance Company Group Vision Care
 		 VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Franklin County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans		 Product Name Form Number
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 		 NVIGRP 5/07-MA
 
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
United HealthCare Insurance Company Group Vision Care
 		 VCOC.INT.06

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Hampden County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans		 Product Name Form Number
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 		 C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 		 NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
United HealthCare Insurance Company Group Vision Care
 		 VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Hampshire County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans		 Product Name Form Number
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Group Eye Care Insurance w/VSP Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 		 NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Standard Insurance Company  Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
United HealthCare Insurance Company Group Vision Care
 		 VCOC.INT.06

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Middlesex County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company
 		 Aetna Vision Preferred
 		 GR-9 et al.
 
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan  VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Access
 		 C-9083MA
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Advantage
 		 C-9083MA
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Insight
 		 C-9083MA
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Select
 		 C-9083MA
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Access
 		 C-9093MA
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Advantage
 		 C-9093MA
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Insight
 		 C-9093MA
 
Fidelity Security Life Insurance Company
 		 EyeMed Vision Plan - Select
 		 C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 		 NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Starmount Life Insurance Company Group Vision Care Insurance VI-2007CT-MA
Starmount Life Insurance Company Group Vision w/Insight Network VI-2007CT-MA-EM
United HealthCare Insurance Company Group Vision Care
 		 VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Nantucket County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans		 Product Name Form Number
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 		 NVIGRP 5/07-MA
 
Principal Life Insurance Company Group Vision Expense GC 9000
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Norfolk County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company
 		 Aetna Vision Preferred
 		 GR-9 et al.
 
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 		 C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 		 C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 		 C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 		 C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 		 NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Starmount Life Insurance Company Group Vision Care Insurance VI-2007CT-MA
Starmount Life Insurance Company Group Vision w/Insight Network VI-2007CT-MA-EM
United HealthCare Insurance Company Group Vision Care
 		 VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Plymouth County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company
 		 Aetna Vision Preferred
 		 GR-9 et al.
 
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan  VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 		 C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 		 C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 		 C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 		 C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 		 NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Starmount Life Insurance Company Group Vision Care Insurance VI-2007CT-MA
Starmount Life Insurance Company Group Vision w/Insight Network VI-2007CT-MA-EM
United HealthCare Insurance Company Group Vision Care
 		 VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Suffolk County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company
 		 Aetna Vision Preferred
 		 GR-9 et al.
 
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan  VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 		 C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 		 C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 		 C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 		 NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Starmount Life Insurance Company Group Vision Care Insurance VI-2007CT-MA
Starmount Life Insurance Company Group Vision w/Insight Network VI-2007CT-MA-EM
United HealthCare Insurance Company Group Vision Care
 		 VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Worcester County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans		 Product Name Form Number
Aetna Life Insurance Company
 		 Aetna Vision Preferred
 		 GR-9 et al.
 
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 		 C-9059MA (05/09)
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 		 C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 		 C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 		 C-9093MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 		 C-9093MA
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 		 NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Starmount Life Insurance Company Group Vision Care Insurance VI-2007CT-MA
Starmount Life Insurance Company Group Vision w/Insight Network VI-2007CT-MA-EM
United HealthCare Insurance Company Group Vision Care
 		 VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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