Ameritas Group—Large & Small Groups

Plan Details.

Dental Summary of Benefits:

• Scheduled PPO Summary of Benefits
• Plan 1200, 1500 & 1500-2 Summary of Benefits

Dental & Vision Summary of Benefits:

• Plan 1500 & 1500-2 FUSION—Exam & Materials Summary of Benefits
• Plan 1500 & 1500-2 FUSION—Materials Only Summary of Benefits

Vision Summary of Benefits:

• Vision Perfect Eye Care Summary of Benefits

Plan Highlights.

Dental Plans:

Plan Name	Plan Highlights
Scheduled PPO
Plan 1200
Plan 1200 w/ Ortho
Plan 1500
Plan 1500 w/ Ortho
Plan 1500-2
Plan 1500-2 w/ Ortho

Dental & Vision Plans:

Plan Name	Plan Highlights
FUSION 1500 Full Vision
FUSION 1500 Materials Only
FUSION 1500 w/ Ortho Full Vision
FUSION 1500 w/ Ortho Materials Only
FUSION 1500-2 Full Vision
FUSION 1500-2 Materials Only
FUSION 1500-2 w/ Ortho Full Vision
FUSION 1500-2 w/ Ortho Materials Only

Vision Plans:

Plan Name	Plan Highlights
Indemnity Eye Care Standalone Full Vision
Indemnity Eye Care Standalone Materials Only

Forms and Applications:

• Ameritas Employer Application
• Ameritas Group Enrollment/Change or Waiver Form
• Ameritas Spanish Enrollment/Change or Waiver Form

Claim Forms:

• Ameritas Dental Claim Form
• Ameritas Eye Care Claim Form

Dental Rewards Program:

• Dental Rewards Flyer

CoPower Manual:

• Ameritas Manual