Page 6 - Affinity Neurocare Benefit Guide - FINAL

Voluntary Vision Option:

Ameritas

Per Pay Period Bi-weekly (26) Dependent Information
Employee Only $ 2.94 We offer our employees their dependents vision coverage.

Employee + Spouse $ 4.98 Children can join or remain on a parent’s vision plan until age
26. When a child turns 26, they will lose vision coverage on
Employee + Child(ren) $ 5.21
the last day of their birth month.
Employee + Family $ 8.16

Vision Benefits — Ameritas In-Network Coverage

Copays:

Network EyeMed Select
Exam $0 Copay

Materials $10 Copay

Standard Contact Fitting Covered in Full

Frequency:
Exams Every 12 Months

Lens Every 12 Months

Frames Every 24 months

Standard Plastic Lens:
Single Vision Covered in Full After Materials Copay

Lined Bifocal Covered in Full After Materials Copay

Lined Trifocal Covered in Full After Materials Copay

Lenticular 20% Discount

Standard Progressive $65 Copay + $10 Materials Copay

Scratch Resistant, UV Coating and Tints $15 Copay

Frames:
Frames Allowance $100 Retail allowance + 20% off balance

Contact Lenses in lieu of eye glasses, materials only:
Frequency Every 12 Months

$115 Retail allowance + 15% off balance and
Lens Allowance
additional contacts

NOTE: This is only is only a brief overview. Please see Benefit Summary more details.
6 Website: www.ameritas.com or Customer Service : 800-659-2223