Community Partners, Inc. Benefits Book 2017

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PREMIUM Employee per month Employee per paycheck
Employee Only $12.13 $6.07
Employee + One $19.41 $9.71
Employee + Children $19.81 $9.91
Employee + Family $31.94 $15.97
VISION PLAN - VISION SERVICE PLAN (VSP)
• Choose from a specific list of vision providers
• Benefits available annually, determined by service dates
VSP SIGNATURE
Description Copay Frequency
WellVision Exam Focuses on your eyes and overall wellness $10 Every 12 Months
Glasses Prescription glasses $25 See Frame and Lenses
Frames • $130 allowance for a wide selection of frames
• 20% off amount over your allowance
Included in prescription
glasses Every 12 Months
Lenses • Single vision, lined bifocal and lined trifocal lenses
• Polycarbonate lenses for dependent children
Included in prescription
glasses Every 12 Months
Lens Options
• Standard progressive lenses
• Premium progressive lenses
• Custom progressive lenses
• Average 35% - 40% off other lens options
$50
$80 - $90
$120 - $160 Every 12 Months
Contacts
(instead of glasses)
• $130 allowance for contacts and contact lens exam
• Contact lens exam (fitting and evaluation)
$0
up to $60 Every 12 Months
Visit for more details on your vision benefit and for exclusive savings and promotions for VSP members.
DENTAL PLAN
AMERITAS Low Plan AMERITAS High Plan
Annual Maximum $1,500 $2,500
Deductible - Waived for preventive $50 $50
Preventive 100% 100%
Basic 80% 80%
Major 50% 50%
Implants Included Included
Orthodontia Deductible None None
Orthodontia - Coinsurance 50% 50%
Orthodontia Maximum $1,000 $1,000
Dental Rewards Program Additional accumulation toward annual maximum
FUSION Benefit Up to $100 may be used for eye exams, frames, lenses, contact lenses
DENTAL PLAN - AMERITAS
• Employees may choose from 2 dental plans offered by Ameritas. CPI pays 100% of the employee only cost of the
Low Plan. Additional coverage may be purchased, pre-tax, through payroll deduction. Dependents added outside of
the initial new hire enrollment or without a qualifying event may be subject to “late enrollee” restrictions. Contact
your HR Representative for details.
• Dental benefits and deductibles are based on the calendar year.
• Participants have 12 months from the date of service to file a claim with Ameritas.
• Both the Low and High plans provide an annual benefit of $1,500 for in-network an out-of-network services. The
High plan provides an additional $1,000 of annual benefit (to a maximum of $2500) if services are through an in-
network provider.
PREMIUM Employee per month Employee per pay Employee per month Employee per pay
Employee Only $0.00 $0.00 $3.52 $1.76
Employee + Family $58.47 $29.24 $67.20 $33.60