Vision Benefits

Ameritas provides access to both VSP and EyeMed vision networks. VSP has the largest network of independent doctors nationwide, while EyeMed has access to five of the top six retail chains, including LensCrafters, Pearle Vision and Target Optical, allowing you to choose the right network to fit your needs.

800.877.7195
www.vsp.com

	In-Network Benefits
Eye Exam	$10 Copay
Materials	$25 Copay
Contact Lens Fit & Follow-up Exam	Member cost up to $60
Frames	$130 allowance; 20% off remaining balance
Lenses Single Vision Bifocal Trifocal Lenticular Progressive	Covered in full Covered in full Covered in full Covered in full Up to contracted fee for bifocal lenses; member responsible for difference
Lens Options: Standard Polycarbonate Scratch Resistant Coating Anti-Reflective Coating Ultraviolet Coating	$33 Copay; covered in full for dependent children $17-$33 Copay $43-$85 Copay $16 Copay
Contact Lenses Medically Necessary Disposable	Covered in full $130 allowance
Frequency
Exam	Every 12 months
Lenses or Contact Lenses	Every 12 months
Frames	Every 24 months

	Semi-Monthly Rate
Employee	$4.22
Employee + Children	$7.18
Employee + Spouse or Domestic Partner*	$6.76
Family	$11.10

*A portion of the vision plan premium contributions for domestic partners is deducted on an after-tax basis unless the domestic partner
qualifies as the employee’s dependent under federal tax laws. Even though domestic partner premiums are not deducted on a pre-tax basis,
the same restrictions for adding or dropping coverage still apply to domestic partners when a qualifying change in status occurs. If you wish
to cover your domestic partner, contact the HR department to obtain additional enrollment information.

Downloads

VSP Low Vision Summary

Vision Policy

VSP Provider Flyer

VSP Highlight Sheet

800.877.7195
www.vsp.com

	In-Network Benefits
Eye Exam	$10 Copay
Materials	$25 Copay
Contact Lens Fit & Follow-up	Member cost up to $60
Frames	$180 allowance; 20% off remaining balance
Lenses Single Vision Bifocal Trifocal Lenticular Progressive	Covered in full Covered in full Covered in full Covered in full Covered in full
Lens Options: Standard Polycarbonate Scratch Resistant Coating Anti-Reflective Coating Ultraviolet Coating	$33 Copay:covered in full for dependent children Covered in full Covered in full $16 Copay
Contact Lenses Medically Necessary Disposable	Covered in full $180 allowance
Frequency
Exam	Every 12 months
Lenses or Contact Lenses	Every 12 months
Frames	Every 24 months

	Semi-Monthly Rate
Employee	$7.30
Employee + Children	$13.02
Employee + Spouse or Domestic Partner*	$14.40
Family	$20.12

Downloads

866.289.0614
www.eyemed.com

	In-Network Benefits
Eye Exam	$10 Copay
Materials	$25 Copay
Contact Lens Fit & Follow-up Exam	Member cost up to $55
Frames	$130 allowance; 20% off remaining balance
Lenses Single Bifocal Trifocal Lenticular Progressive	Covered in Full Covered in Full Covered in Full 20% discount Standard: $65 + lens deductible Premium: lens cost - 20% discount - $120 allowance + Standard Progressive cost
Lens Options: Standard Polycarbonate Scratch Resistant Coating Anti-Reflective Coating Ultraviolet Coating	$40 Copay $15 Copay $45 Copay $15 Copay
Contact Lenses Medically Necessary Disposable	Covered in full $130 allowance
Frequency
Exam	Every 12 months
Lenses or Contact Lenses	Every 12 months
Frames	Every 24 months