Voluntary Vision Plan

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• Eligibility
• Enrollment
• Plan Highlights
• Rates

Forms & Publications

• Voluntary Vision Plan Handbook
• Retiree Vision Enrollment/Change Form (SFN 53505)
• Vision Claim Form
• Employer Verification of Insurance Coverage (SFN 53621)
• Retiree Authorization for Premium Deduction (SFN 50134)
• TFFR Payroll Deduction Authorization (SFN 19182)

Claim Filing

Ameritas Life Insurance Corp.
Group Claim Office
P O Box 82520
Lincoln NE 68501
1-800-255-4931

Policy Holder: North Dakota Public Employees Retirement System
Group Policy Number: 010-350308-00000