Vision Plan Summary
Metropolitan Life Insurance Company
In-network benefits There are no claims for you to file when you go to a participating vision specialist. Simply pay your copay and, if applicable, any amount over your allowance at the time of service. Frequency Once every 12 months • Eye health exam, dilation, prescription and refraction for glasses: Covered in full after a $10 copay. • Retinal imaging: Up to a $39 copay on routine retinal screening when performed by a private practice provider. Eye exam
With your Vision Preferred Provider Organization Plan, you can: • Go to any licensed vision specialist and receive coverage. Just remember your benefit dollars go further when you stay in network. • Choose from a large network of ophthalmologists, optometrists and opticians, from private practices to retailers like Costco ® Optical, Walmart, Sam’s Club and Visionworks. In-network value added features: Additional lens enhancements: In addition to standard lens enhancements, enjoy an average 20-25% savings on all other lens enhancements. 1 Savings on glasses and sunglasses: Get 20% savings on additional pairs of prescription glasses and non- prescription sunglasses, including lens enhancements. At times, other promotional offers may also be available. 1
Frame • Allowance: $130 after $20 eyewear copay. • Costco, Walmart and Sam’s Club: $70 allowance after $20 eyewear copay.
Once every 24 months
You will receive an additional 20% savings on the amount that you pay over your allowance. This offer is available from all participating locations except Costco, Walmart and Sam’s Club.
Standard corrective lenses Once every 12 months • Single vision, lined bifocal, lined trifocal, lenticular: Covered in full after $20 eyewear copay.
Standard lens enhancements 1 Once every 12 months • Polycarbonate (child up to age 18) and Ultraviolet (UV) coating: Covered in full after $20 eyewear copay. • Progressive Standard, Progressive Premium/Custom, Polycarbonate (adult), Photochromic, Anti-reflective, Scratch-resistant coatings and Tints: Your cost will be limited to a copay that MetLife has negotiated for you. These copays can be viewed after enrollment at www.metlife.com/mybenefits.
Contact lenses instead of eye glasses • Contact fitting and evaluation: Covered in full. • Elective lenses: $130 allowance. • Necessary lenses: Covered in full after eyewear copay.
Once every 12 months
Laser vision correction: 2 Savings averaging 15% off the
regular price or 5% off a promotional offer for laser surgery including PRK, LASIK and Custom LASIK. This offer is only available at MetLife participating locations.
We’re here to help Find a Vision provider at www.metlife.com/vision
Download a claim form at www.metlife.com/mybenefits
For general questions go to www.metlife.com/mybenefits or call 1-855-MET-EYE1 (1-855-638-3931)
200 Park Ave., New York, NY 10166 © 2020 MetLife Services and Solutions, LLC L0919518536[exp1220][All States]
VI-STAND Vision Benefit Summary
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