Page 17 - SC Fuels EE Guide 2020 National

VISION PLAN CHOICES

Ameritas | Voluntary Vision Plans
SC Fuels provides vision coverage through Ameritas. You may choose between the EyeMed Access network or
the VSP network. With both plans, you can see an in-network provider or an out-of-network provider, however,
your costs will be lower if you visit an in-network provider. You may access your vision plan by providing your
eye doctor with your social security number (your dependents will need to provide your social security number).
Please note, ID cards will not be provided and are not needed to use the plan.

Ameritas Ameritas
EyeMed VSP
Network Name EyeMed Access Non-Network VSP Non-Network
Vision Benefits
Team Member Rate Per Paycheck
• Team Member Only $4.02 $5.78
• Team Member + Spouse $8.04 $11.30
• Team Member + Child(ren) $7.10 $10.16
• Team Member + Family $11.12 $15.66
Deductibles $10 Examination $10 Examination
$25 Eye Glass Lenses $25 Eye Glass Lenses or Frames
Examination (Every 12 Months) No Charge $35 Allowance No Charge $52 Allowance
Lenses (Every 12 Months)
• Single Vision No Charge $25 Allowance No Charge $55 Allowance
• Bifocal No Charge $40 Allowance No Charge $75 Allowance
• Trifocal No Charge $55 Allowance No Charge $95 Allowance
Frames (Every 12 Months) $130 Allowance $65 Allowance $130 Allowance $70 Allowance
Contact Lenses (Every 12 Months) (in lieu of frames and lenses) (in lieu of frames and lenses)
• Cosmetic / Elective $130 Allowance $104 Allowance $130 Allowance $105 Allowance

FINDING A VISION PROVIDER The EyeMed network includes access
to independent ophthalmologists and
EyeMed Access Network optometrists, as well as LensCrafters,
• Visit www.ameritas.com - click Target Optical, and most Pearle Vision retail
“Find a Provider” and choose stores.
Vision: EyeMed Access Plan
Network VSP has the largest network of private-
VSP Network practice eye care doctors in the industry,
• Visit www.ameritas.com - click and also contracts with Costco Optical,
“Find a Provider” and choose Visionworks, and other affiliate retail
Vision: VSP providers.

Laser Vision Correction Discounts
• EyeMed: Average 15% off retail price or 5% off promotional price for LASIK or PRK at
US Laser Network participating providers.
• VSP: Average 15% off retail or 5% off promotional price. The maximum out-of-
pocket per eye is $1,800 for LASIK and $2,300 for custom LASIK using Wavefront
technology, and $1,500 for PRK. In order to receive the benefit, a VSP provider must
coordinate the procedure.

TEAM MEMBER BENEFITS | 17