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Vision Care Program Detailed Table of Contents
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Table of Contents
Detailed Table of Contents
Index

Introduction

Who Is Eligible

Glossary of Key Terms – Eligibility

General Information

Your Eligible Dependents

Extended Coverage for Full-Time Status Students Age 19 and Older

Extended Coverage for Disabled Children

Qualified Medical Child Support Order (QMCSO)

If You Are Reemployed

For Employees of New Participating Subsidiaries and/or Participating Employers

Enrolling for Coverage

General Information

Your Contributions

Enrolling Yourself and Your Eligible Dependents

When Coverage Begins

Adding Dependents

If You Are Not Actively at Work

If You Do Not Enroll by the Deadline

Qualified Status Changes

Special Enrollment Opportunities

Significant Cost or Coverage Change

Annual Enrollment

How the Program Works

General Information

Key Features

When Coverage Ends

General Information

If You Leave the Company, Retire, or Are No Longer Eligible for Coverage

If Your Employee Group Goes on Strike

Special Extensions of Coverage

General Information

During a Leave of Absence

Uniformed Services Employment and Reemployment Rights Act of 1994

If You Receive Disability Benefits

Your Legal Right to Continuation Coverage Under COBRA

General Information

Notification

Election Procedure

Disability Extension

Other Extension

Payment

When Continuation Coverage Ends

Trade Act Implications

Claims and Appeals Procedures

General Information

Procedure for Filing a Claim

Defective Claims

Initial Claim Review

Initial Benefit Determination

Post-Service Claim

Manner and Content of Notification of Denied Claim

Review of Initial Benefit Denial

Procedure for Filing an Appeal of a Denial

Review Procedures for Denials

Timing of Notification of Benefit Determination on Review

Manner and Content of Notification of Benefit Determination on Review

Situations Affecting Your Benefits

General Information

If the Group Benefits Plan Is Modified or Ended

Summary of Vision Plan

Administrative and Contact Information

General Information

Type of Plan

Plan Sponsor

Employer Identification Number of Plan Sponsor

Plan Name and Number

Plan Year End

Agent for Service of Legal Process

Benefits Committee and Plan Administrator

Eligibility Administration

Claims Administrator

Claims Administrator for Eligibility Claims

COBRA Administrator for Continuation Coverage

Allocation and Delegation of Fiduciary Responsibilities by the Benefits Committee

Trust and Insurance

Insured Benefits

Your ERISA Rights

General Information

Receive Information About Your Program and Benefits

Continue Group Health Plan Coverage

Prudent Actions by Plan Fiduciaries

Enforce Your Rights

Assistance With Your Questions

Vision Care Program

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Introduction

The Vision Care Program (the “Program”) available at R.R. Donnelley & Sons Company (“RR Donnelley”) offers you and your eligible dependents access to comprehensive coverage for exams, lenses, frames, and contact lenses through a network of providers.

Your Vision Care Program option is included with your enrollment information. As long as you are eligible, you can elect coverage under the Program for yourself and your eligible dependents.

You pay the full cost of your vision coverage; however, RR Donnelley does provide a group rate for you and your family. Therefore, it is important that you know how the Program works. Become an informed consumer of vision care services, read all of the benefits information available, and ask questions so that you can make coverage decisions that are best for you and your family.

This information, together with the certificate of coverage attached here, is the Summary Plan Description (SPD) for the Program and explains your vision care coverage as of January 1, 2006 (unless noted otherwise).

This SPD explains vision care coverage under the Program as of January 1, 2006. It details who is eligible for coverage, how to enroll for coverage, and when coverage begins and ends. It details which expenses are and are not covered under the Program, and it describes how to file a claim and your rights under the Program. Please read this information to familiarize yourself with your coverage.

The Plan document for the Vision Care Program is entitled the R.R. Donnelley & Sons Company Group Benefits Plan (“Group Benefits Plan”). It governs the Vision Care Program and includes additional details on how the Program operates.

EyeMed is the claims administrator and network manager for the Program.

You are eligible for coverage under the Program only if you are an employee of a participating employer or subsidiary. If you are an employee of an employer or subsidiary that does not participate in the Group Benefits Plan, you are not eligible for the benefits described in this SPD. To find out if you are eligible for these benefits, contact the eligibility administrator.

This SPD and any supplemental information attempt to be as complete, accurate, and up-to-date a description as possible of your coverage under the Program. If there is any discrepancy between this SPD versus the Group Benefits Plan and the vision insurance contract, the actual Group Benefits Plan document and the vision insurance contract always govern.

In addition, nothing in this SPD should be interpreted as an employment contract. This summary merely describes the coverage offered to eligible employees as of January 1, 2006. RR Donnelley reserves the right to change or terminate the Group Benefits Plan or Program, in whole or in part, at any time.

This content contains a summary in English of your rights and benefits under the Program. If you have difficulty understanding any part of this content, call the RR Donnelley Benefits Center at 1-877-RRD-4BEN (1-877-773-4236). Benefits Center Representatives are available between the hours of 8 a.m. and 5 p.m. CT, Monday through Friday, except holidays.

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