Ameritas Vision Summary of Benefits
Columbia County Board of Education

Effective January 1, 2008 through December 31, 2008

The plan covers all routine eye care, including eye exams and eyeglasses (lenses and frame) or contacts.

Rates for Visions Care:	High Plan	Low Plan
Employee only	$7.32	$5.20
Employee + one	$14.64	$10.40
Employee + family	$20.96	$14.64

HIGH PLAN

EyeMed integrated network gives members a true choice in provider selection, with an extensive choice of
private practice optometrists, ophthalmologists, opticians and retailers including the nations leading optical
retailer, LensCrafters®. EyeMed offers total value in vision care by integrating with Luxottica, one of the world’s leading eyeglass frame manufacturer, LensCrafters, the nations #1 optical retailer and our wide and diverse network of independent providers. This provides savings without sacrificing quality and service.

Member will receive a 20% discount on remaining balance at Participating EyeMed Providers beyond plan
coverage, which may not be combined with any other discounts or promotional offers, and the discount does
not apply to EyeMed's Providers professional services, disposable contact lenses or services provided by laser providers. Your EyeMed benefit also provides for continued savings through our Premier Plus Secondary
Purchase Plan. After you initial benefits have been utilized, you are able to receive ongoing discounts on
additional eyewear purchases at EyeMed provider locations, which result in discounts up to 45% off the
retail price of eyewear and accessories. See your EyeMed provider for details.

In addition, EyeMed has arranged for members to receive a discount off laser assisted in-situ keratomileusis
(LASIK) and photorefractive keratectomy (PRK) laser surgery. LASIK and PRK vision correction procedures
receive 15% off retail price or 5% off promotional pricing. (LASIK and PRK correction procedures are provided
by the U.S. Laser Network, owned by LCA-Vision. Members must first call 1-877-5LASER6 for the nearest
facility and to receive authorization for the discount.)

Plan Design

	Benefits with	Maximum Covered Expense
Service	Panel Doctor (*)	with Non-Panel Doctor
Annual Vision Exam	100% Covered (w/ $10.00 co-pay)	$ 35.00 (****)
Frame	$80.00 (**)	$ 35.00 (****)
Single Vision Lenses	100% Covered	$ 25.00 per pair (****)
Bifocal Lenses	100% Covered	$ 40.00 per pair (****)
Trifocal Lenses	100% Covered	$ 55.00 per pair (****)
Lenticular Lenses	100% Covered	$ 55.00 per pair (****)
Contact Lenses - medically necessary (***)	$250.00 per pair (****)	$200.00 per pair (****)
Contact Lenses - elective(****)	$90.00 per pair (****)	$80.00 per pair (****)

Lens option: Progressive Lenses (standard only) -Patient will be charged $65.00 in addition to the $25.00 lens deductible.

*	Patient is responsible for $10.00 annual deductible on exams and $25.00 lens deductible.
**	EyeMed provides a $80.00 allowance toward a new frame. If the Insured chooses a frame valued at more than the plans allowance, you will receive a 20 percent discount on the amount over your frame allowance.
***	When contact lenses are selected: 1. The Insured is eligible for an exam and contact lenses. Other limitations and provisions of the policy will apply. The benefit for the examination will be reimbursed as shown above.
	2. The exam, lens, and frame benefit will not be available for the next 12 month period following the date of service. See limitations section for list of services not covered.
****	Patient pays remainder

Frequency Allowance

Exam	every 12 Months
Lens	every 12 Months
Frames	every 12 Months

*Monthly Rates*	Eye Care Rates
Employee	$7.32
Employee & One Dependent	$14.64
Employee & Two or More Dependents	$20.96

Highlights of the vision coverage available through Ameritas Group Insurance Corp., a division of Ameritas Life Insurance Corporation, and does not include applicable exclusions and limitations. Please refer to the Certificate of Insurance for a complete list of covered procedures and applicable exclusions and limitations.

Limitation and Exclusions

No benefits are payable for a service which is not listed under the list of eye care services.

Covered Expenses will not include and no benefits will be payable for expenses incurred for:

1.	vision examinations more than the frequency as indicated on the plan definition page.
2.	lenses more than the frequency as indicated on the plan definition page, and then only if replacement is deemed necessary by the Provider.
3.	frames more than the frequency as indicated on the plan definition page, and then only if replacement is deemed necessary by the Provider.
4.	contact lenses more than once in any twelve month period. When chosen, contact lenses shall be in lieu of any other lens benefit during the twelve month period. When lenses and frames are chosen, expenses for contact lenses are not Covered Expenses during the twelve month period.
5.	medically necessary contact lenses, except for the first $250 of expense, when such lenses are purchased for any reason other than for the following conditions:
	a. following cataract surgery.
	b. to correct extreme visual problems that cannot be corrected with spectacle lenses.
	c. certain conditions of anisometropia.
	d. keratoconus.
	such payment is limited to once in any twelve-month period and is in lieu of lenses and frame benefits under this policy.
6.	orthoptics or eye care training and any associated testing.
7.	plano lenses.
8.	two pairs of glasses in lieu of bifocals.
9.	lenses and frames which are lost or broken, except at the normal intervals when services are otherwise available.
10.	medical or surgical treatment of the eyes.
11.	the following materials, over and above the Covered Expense for the basic material. These materials are cosmetic and the Insured will be responsible for the cost of these materials.
	a. photo chromatic lenses; tinted lenses except pink #1 and #2
	b. the coating of the lens or lenses
	c. the laminating of the lens or lenses
	d. frames exceeding the cost agreed to by the Participating Provider and the Company.

TO LOCATE EYEMED PARTICIPATING PROVIDERS FOR THE AREA - VIEWPOINT PLAN, PLEASE CLICK ON THE FOLLOWING LINK: EYEMED PROVIDER LOCATER

LOW PLAN

Vision Perfect is an eye care product offered across the nation to businesses, large and small, by Ameritas
Group Insurance Corp. With Vision Perfect each insured individual can select the physician to provide eye care
services based on his or her own preference. Benefits are reimbursed solely on the scheduled/defined
amounts of the plan design chosen by the group, so there are no billing surprises for employees. Employees
will appreciate the freedom to choose their own eye care provider without being penalized. Employers will
appreciate the ability to choose benefit levels to fit the total company benefit program.

Plan Design

Deductible - Lifetime Deductible:	Exams	Waived
	Lenses	$0.00
	(Other than contact lenses)
	Frames/Contact lenses	$40.00

	MAXIMUM COVERED
Service	EXPENSE
Vision Examination	$45.00
Frames	$40.00
Lenses (Per pair of lens - Patient pays remainder)
Single Vision	$35.00
Bifocal	$50.00
Trifocal	$65.00
No line bifocal or progressive power	$70.00
Lenticular	$70.00

Contact Lenses	$75.00

The patient will be responsible for any deductible, if applicable, and any cost over the specified plan benefits as stated above.

Frequency Allowance
Exam	every 12 months
Lens	every 12 months
Frames	every 12 months

*Monthly Rate*	Eye Care Rates
Employee	$5.20
Employee & One Dependent	$10.40
Employee & Two or More Dependents	$14.64

This form highlights the vision coverage available through Ameritas Group Insurance Corp., a division of Ameritas Life Insurance Corporation, and does not include applicable exclusions and limitations. Please refer to the Certificate of Insurance for a complete list of covered procedures and applicable exclusions and limitations.