fulfilling life
Group benefits proposal for CITY OF VERNON
Lynn Nguyen
151 Kalmus Dr, Suite J4
Costa Mesa, CA 92626
818-907-9071
License #0K16753
Eye Care Insurance Proposal
Presented By
KEENAN & ASSOCIATES
License #0451271
August 28, 2025
Ameritas Life Insurance Corp.
2 Based on the information provided to
us, we've prepared this proposal to
meet the needs of CITY OF VERNON
and its people. Every benefits solution
we offer -- from fully insured coverage
to administrative service arrangements
-- represents our promise to provide
products that help protect the health of
your employees and serve your
organization. If any of your information
or needs change, we will be happy to
provide an updated proposal.
Eye Care Plan Design Summary.........3
Eye Care Features/Benefits ................6
Assumptions/Requirements.................7
Limitations/Exclusions .........................9
ameritas.com
CITY OF VERNON
Plan Design Summary
3 Eye Exam, Lenses, Frames, Frequencies Proposed Effective Date: 01/01/2026 Plan 1: ViewPointe® Plan 2: Focus®
EyeMed Insight Network Out of Network VSP Choice Network + Affiliates
Out of Network
Annual Eye Exam Covered in full Up to $35 Covered in full Up to $45 Lenses (per pair)
Single Vision Covered in full Up to $25 Covered in full Up to $30 Bifocal Covered in full Up to $40 Covered in full Up to $50 Trifocal Covered in full Up to $55 Covered in full Up to $65 Lenticular 20% discount No benefit Covered in full Up to $100 Progressive See lens options NA See lens options NA
Frame Allowance $150 Up to $75 $150** Up to $70
Frequencies
Exam/Lens/Frames 12/12/12 12/12/12 12/12/12 12/12/12
Based on date of service Based on date of service Based on date of service Based on date of service **The Costco and Walmart allowance will be the wholesale equivalent.
Deductible, Maximum
Deductibles
$0 Exam No deductible $0 Exam $0 Exam
$0 Eye Glass Lenses $0 Eye Glass Lenses or
Frames*
$0 Eye Glass Lenses or
Frames
Maximum
per benefit period None None None None
*Deductible applies to a complete pair of glasses or to frames, whichever is selected.
Contact Lenses
Fit & Follow Up
Exams
Standard: Member cost up
to $40
No benefit Member cost up to $60 No benefit
Premium: 10% off of retail No benefit
Contacts
Elective Up to $150* Up to $120 Up to $150* Up to $120
Medically Necessary Covered in full Up to $200 Covered in full Up to $210 *Glasses and Contact Lens covered in same benefit period Monthly Rates
Employee (EE) $8.72 $10.56
EE + 1 Dependent $16.16 $19.08
EE + 2 or more
Dependents
$23.64 $27.56
Rates are guaranteed for 24 months following the effective date listed above.
Rates include: home address mailing.
PLEASE NOTE: Rates assume enrollment in our electronic certificate (eCert) program. If you choose to receive paper certificates, monthly rates will increase.
Employee Participation Requirements Eligible Employees: 336 The greater of 75% or 3 lives The greater of 75% or 3 lives Voluntary Voluntary
CITY OF VERNON
Plan Design Summary
4 Lens Options (member cost)*
Plan 1: ViewPointe® Plan 2: Focus®
EyeMed Insight Network Out of Network VSP Choice Network + Affiliates
Out of Network
(Other than Costco)
Progressive Lenses
Standard $65 + lens deductible No benefit $55 Up to Lined Bifocal allowance.
Premium Up to provider's
contracted fee for Lined
Bifocal Lenses. The
patient is responsible for
the difference between the
base lens and the
Progressive Lens charge.
Up to Lined Bifocal
allowance.
Tier 1 $85 + lens deductible No benefit NA NA
Tier 2 $95 + lens deductible No benefit NA NA
Tier 3 $110 + lens deductible No benefit NA NA
Tier 4 $65 plus 80% of charge
less $120 allowance
No benefit NA NA
Std. Polycarbonate $40 No benefit Covered in full for
dependent children $33
adults
No benefit
Scratch Resistant
Coating
$15 No benefit $17-$33 No benefit
Anti-Reflective
Coating
$43-$85 No benefit
Standard $45 No benefit NA NA
Premium
Tier 1 $57 No benefit NA NA
Tier 2 $68 No benefit NA NA
Tier 3 80% of the charge No benefit NA NA
Ultraviolet Coating $15 No benefit $16 No benefit
LASIK or PRK Average discount of 15%
off retail price or 5% off
promotional price at US
Laser Network
participating providers.
No benefit NA NA
*Lens Option member costs vary by prescription, option chosen and retail locations.
CITY OF VERNON
Plan Design Summary
5 Additional Focus® Choice Network Features (In Network) (Plan(s) 2) Contact Lenses
Elective
Allowance can be applied to disposables, but the dollar amount must be used all at once (provider will order 3 or 6 month supply). Applies when contacts are chosen in lieu of glasses. For plans without a separate contact fitting & evaluation (which includes follow up contact lens exams), the cost of the fitting and evaluation is deducted from the allowance.
Lens Options
(Member Cost)*
$15 - Solid Plastic Dye (Except Pink I & II)
$17 - Plastic Gradient Dye
$31-$82 - Photochromatic Lenses (Glass & Plastic)
Lens Option member cost vary by prescription and option chosen.
Additional Glasses 20% off additional complete pairs of prescription glasses and/or prescription sunglasses.* Frame Discount VSP offers 20% off any amount above the retail allowance.* Laser VisionCareSM VSP offers an average discount of 15% off or 5% off a promotional offer for LASIK Custom LASIK and PRK.
The maximum out-of-pocket per eye for members 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.
Low Vision With prior authorization, 75% of approved amount (up to $1,000 is covered every two years).
Based on applicable laws, reduced costs may vary by doctor location.
Additional ViewPointe® Features (In Network) (Plan(s) 1) Discounts 15% discount on the remaining balance in excess of the conventional contact lens allowance. 20% discount on the remaining balance in excess of the frame allowance. 20% discount on items not covered by the plan at network providers, which may not be combined with any other discounts or promotional offers. This discount does not apply to EyeMed Provider's professional services, or contact lenses.
Lens Options
(Member Cost)
$15 - Tint (Solid & Gradient).
$75 - Plastic Photochromatic/Transition.
Secondary Purchase
Plan
Members receive a 40% discount on a complete pair of glasses once the funded benefit has been exhausted. Members receive a 15% discount off the retail price on conventional contact lenses once the funded benefit has been exhausted. Discount applies to materials only.
Contact Lens
Replacement by Mail
Program
After exhausting the contact lens benefit, replacement lenses may be obtained at significant discounts online. Visit EyeMedvisioncare.com for details.
CITY OF VERNON
Features/Benefits
6 Ameritas Focus® Eye Care
VSP Network
VSP has the largest network of independent doctors nationwide. Retailers include Costco Optical, Sam's Club, Visionworks and Walmart. See the network providers in your area at vsp.com.
Online In-Network Options
Eyeconic.com is VSP's in-network online eyewear store. Vision benefits are applied directly to the online order.
VSP Benefits are Easy to Use
⚫ Members create an account at vsp.com to review their vision benefits. ⚫ At their appointment, members tell the office they have VSP coverage. No ID card is needed. For reference, an ID card can be printed from their member account.
⚫ There are no claim forms to complete when seeing a VSP network provider.
VSP savings
VSP provider discounts include 20% off the remaining frame balance, additional prescription glasses, and non-covered lens options.
Discounts also are available on LASIK or PRK laser vision correction procedures.
Based on applicable laws, reduced costs may vary by doctor location.
Ameritas ViewPointe® Eye Care
EyeMed Network
Five of the top six national retail chains accept EyeMed, including LensCrafters, Pearle Vision and Target Optical. See network providers in your area at eyemed.com.
Online In-Network Options
Glasses.com and Contacts Direct are in the EyeMed network, and your vision benefits are applied directly to your online order.
EyeMed Benefits are Easy to Use
⚫ Members create an account at eyemed.com to review their vision benefits. ⚫ At their appointment, members tell the office they have EyeMed coverage. No ID card is needed. For reference, an ID card can be printed from their member account.
⚫ There are no claim forms to complete when seeing an EyeMed network provider.
EyeMed savings
EyeMed provider discounts include 20% off the remaining frame balance, materials not covered by the plan, and non-prescription sunglasses.
Discounts also are available on LASIK or PRK laser vision correction procedures.
Based on applicable laws, reduced costs may vary by doctor location.
CITY OF VERNON
Assumptions/Requirements
7 ⚫ If you purchase group insurance through Ameritas, your producer will receive compensation from Ameritas Group. This compensation may include one or more of the following:
⚫ Commission or override commission based on customary or negotiated scales. ⚫ Additional compensation based on factors such as the volume of premium, cases or lives placed by your producer with Ameritas, or persistency.
⚫ Fees for administrative or consulting services.
If you have any questions about the amount or type of compensation, please contact your producer. ⚫ Some states require that producers be appointed with Ameritas Life Insurance Corp. before any presentation or solicitation of this plan design.
⚫ This proposal is not a contract or a certificate of insurance. It contains proposed rates and benefits that are based on preliminary enrollment data. Such rates and benefits are subject to adjustment if final enrollment varies from the preliminary data. ⚫ The rates are based on Standard Industry Code 922011. ⚫ This proposal is based on the assumption it will be sold in conjunction with a bona fide cafeteria plan regulated by Section 125 of the Internal Revenue code, and it must meet all of the Section 125 requirements. Ameritas Life Insurance Corp. reserves the right to request a copy of the employer's Section 125 cafeteria plan. If you select Ameritas Life Insurance Corp.'s plan and implement it through a cafeteria approach regulated by Section 125, we will require that all eligible employees and dependents requesting benefits: (a) make annual selections, and (b) remain in the plan for a minimum of one year. Changes in these selections will not be allowed except for certain "life event" or family status changes such as marriage, birth, death or termination of employment. ⚫ Benefits could be available for all full-time, active employees working at least 30 hours per week and dependents who have completed the designated waiting period.
⚫ This proposal is being made as a result of information provided in the request for a proposal. It is intended for informational purposes and is not an offer to contract. If CITY OF VERNON wishes to apply for group insurance based upon this proposal, CITY OF VERNON may complete a Preliminary Application for Group Insurance. The Application will be subject to review and approval by the Home Office of the Company. If the Application is accepted, the final rates and benefits will be based on verification of this information and final enrollment.
⚫ California state law requires that coverage shall be provided to Registered Domestic Partners that is equal to, and subject to the same terms and conditions as, the coverage provided to a spouse. Registered Domestic Partner means a partner of the Insured as long as the partnership meets the requirements for such relationship as defined in Section 297 of the California Family Code or the functional equivalent registration of any other state or local jurisdiction. ⚫ Ameritas does not issue coverage to individuals residing in Europe. ⚫ The situs State of California has passed legislation which requires dependent children to be considered covered up to age 26 regardless of student status.
⚫ For residents of New Mexico, coverage will be administered in accordance with the minimum benefit standards required by New Mexico law. Please consult your sales representative with questions regarding these requirements. ⚫ Please let us know if you need a Spanish-language version of the Certificate.
CITY OF VERNON
Assumptions/Requirements
8 ⚫ This proposal assumes 0% of the benefit eligible employees are retirees. If this percentage changes, Ameritas Life Insurance Corp. reserves the right to revise the rates retroactive to the effective date of the vision benefits to accommodate this change. (Plan(s): 1, 2)
⚫ No benefits are payable for a service which is not listed under the list of eye care services. ⚫ This plan is provided as part of the Policyholder's Section 125 Plan. Each employee has the option under the Section 125 Plan of participating or not participating in this plan. If an employee does not elect to participate when initially eligible, he/she may elect to participate at the Policyholder's next Annual Election Period. ⚫ Employees electing coverage on the January 1, 2026, effective date must remain in the plan for the first 24 months. Employees will be allowed an election period on January 1, 2026. (Plan(s): 1) ⚫ This proposal assumes a Section 125 plan year of January 1 to January 1. The first plan year will run January 1, 2026 through January 1, 2028. Subsequent plan years will be on a January 1 to January 1 basis to coincide with the Section 125 plan year.
Please check with your tax advisor regarding the long plan year. (Plan(s): 1) ⚫ Employees electing coverage on the January 1, 2026, effective date must remain in the plan for the first 24 months. Employees will be allowed an election period on January 1, 2026. (Plan(s): 2) ⚫ This proposal assumes a Section 125 plan year of January 1 to January 1. The first plan year will run January 1, 2026 through January 1, 2028. Subsequent plan years will be on a January 1 to January 1 basis to coincide with the Section 125 plan year.
Please check with your tax advisor regarding the long plan year. (Plan(s): 2)
CITY OF VERNON
Eye Care Limitations/Exclusions
9 Covered Expenses will not include and no benefits will be payable for expenses incurred for:
Limitations for Plan(s) 1
⚫ vision examinations more than the frequency as indicated on the plan summary page. ⚫ lenses more than the frequency as indicated on the plan summary page. ⚫ frames more than the frequency as indicated on the plan summary page. ⚫ 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 eyeglass lenses are chosen, expenses for contact lenses are not Covered Expenses during the twelve month period.
⚫ contacts limited to the amount shown on the plan summary page unless they are medically necessary. Contact lenses are defined as medically necessary if the individual is diagnosed with one of the following conditions:
⚫ keratoconus where the patient is not correctable to 20/30 in either or both eyes using standard spectacle lenses. ⚫ High Ametropia exceeding -10D or +10D in meridian powers. ⚫ anisometropia of 3 D or more.
⚫ patients whose vision can be corrected two (2) lines of improvement on the visual acuity chart when compared to best corrected standard spectacle lenses.
If the member is diagnosed with a medically necessary condition, the Provider will submit a request for pre-authorization to EyeMed. The Medical Director reviews all requests for medically necessary contact lenses. If approved, the member will be covered for medically necessary contact lenses up to the plan allowance.
Such payment is limited to once in any twelve month period and is in lieu of lens benefits under this proposal. ⚫ orthoptics or eye care training and any associated testing. ⚫ plano non-prescription lenses and non-prescription sunglasses (except for 20% discount). ⚫ two pairs of glasses in lieu of bifocals. (Does not apply to Secondary Discounts). ⚫ lenses and frames which are lost or broken, except at the normal intervals when services are otherwise available. ⚫ medical and/or surgical treatment of the eye, eyes, or supporting structures. ⚫ services for which a claim is filed more than 1 year after completion of the service. ⚫ for any procedure not listed on the Schedule of Eye Care Services.
This plan has the following limitation: (Plan 2)
Some brands of spectacle frames may be unavailable at all locations for purchase as Covered Expenses, or may be subject to additional out-of-pocket expenses. Members may obtain details regarding frame brand availability from their treating provider or by calling VSP's Customer Care Division at (800) 877-7195.
This plan does not cover: (Plan 2)
⚫ More than one eye exam in the frequency as indicated on the plan summary page. ⚫ More than one pair of lenses in the frequency as indicated on the plan summary page. ⚫ More than one set of frames in the frequency as indicated on the plan summary page. ⚫ Services and/or materials not specifically included in the Schedule as covered Plan Benefits. ⚫ Plano lenses (lenses with refractive correction of less than plus or minus .50 diopter) except as specifically allowed in the frames benefit section of the Plan Benefits.
⚫ Services or materials that are cosmetic, including Plano contact lenses to change eye color and artistically painted Contact Lenses.
⚫ Two pairs of glasses in lieu of Bifocals.
⚫ Replacement of Spectacle Lenses, Frames, and/or contact lenses furnished under this plan that are lost or damaged, except at the normal intervals when services are otherwise available. ⚫ Orthoptics or vision training and any associated supplemental testing. ⚫ Medical or surgical treatment of the eyes.
⚫ Contact lens modification, polishing or cleaning.
⚫ The refitting of Contact Lenses after the initial 90-day filing period. ⚫ Contact Lens insurance policies or service contracts. ⚫ Additional office visits associated with contact lens pathology. ⚫ Local, state and/or federal taxes, except where law requires us to pay.