PATENT PENDING VSN125FL.1
AMERICAN FAMILY LIFE ASSURANCE COMPANY OF COLUMBUS (AFLAC)
WORLDWIDE HEADQUARTERS: 1932 WYNNTON ROAD, COLUMBUS, GEORGIA 31999
TOLL-FREE 1-800-99-AFLAC (1-800-992-3522)
Visit our Web site at aflac.com.
VISION INSURANCE POLICY
Outline of Coverage for Policy Form VSN100FL
LIMITED BENEFIT INSURANCE
THIS IS NOT MEDICARE SUPPLEMENT COVERAGE.
Notice to Buyer: This policy provides Vision benefits only.
If you are eligible for Medicare, review the Medicare Supplement Buyer's Guide furnished by Aflac.
I. READ YOUR POLICY CAREFULLY: This Outline of Coverage provides a very brief description of some
of the important features of your policy. This is not the insurance contract, and only the actual policy
provisions will control. The policy itself sets forth, in detail, the rights and obligations of both you and
Aflac. Therefore, it is important that you READ YOUR POLICY CAREFULLY.
II. LIMITED BENEFIT HEALTH COVERAGE: Policies of this category are designed to provide, to persons
insured, limited or supplemental coverage.
III. BENEFITS: Subject to the waiting period, if any, listed in the Vision Correction Benefit and the provisions
in the Limitations and Exclusions section, we will pay the following benefits when a charge is incurred for
covered vision treatment that occurs while coverage is in force.
A. EYE EXAMINATION BENEFIT: Aflac will pay $35 (thirty-five dollars) when a charge is incurred for an
eye examination for a covered person. This benefit is limited to one examination per covered person
per Policy Year. The eye examination must be performed by an Optometrist or Ophthalmologist. No
While the policy is in force, the following benefits will be paid, subject to Part 2, Limitations and
Exclusions of your policy, and all other policy provisions. Please see section (IV) of this outline of
B. VISION CORRECTION BENEFIT: The option you have chosen on your application is indicated
below by a check mark in the appropriat