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KEY BENEFITS
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MetLife Vision Low Plan (M100D-20/20) | MetLife Vision High Plan (M150A-0/0) | |||
Enrollment Deadline | 18th of month Prior to Effective date | 18th of month Prior to Effective date | ||
Provider Seach | Search for Providers | Search for Providers | ||
Reimbursement | In-Network Coverage (Using a Network Provider) | Out-of-Network Reimbursement (Using a NonÂNetwork Provider) | In-Network Coverage (Using a Network Provider) | Out-of-Network Reimbursement (Using a NonÂNetwork Provider) |
States Not Available | ||||
AK, AZ, CA, ID, LA, ME, MD, MT, NH, NM, OR, SD, WA, WV | ||||
Eye Examination | ||||
Comprehensive exam of visual functions and prescription of corrective eyewear. | $20 copay | $45 allowance | $0 copay | $45 allowance |
Retinal Imaging This screening is used to take pictures of the inside of the eye particularly the retina to look for possible changes. | Up to $39 copay | Applied to the exam | Up to $39 copay | Applied to the exam allowance |
Materials / Eyewear (Either Glasses or Contacts) | ||||
Standard Corrective Lenses | ||||
Single vision | $20 copay | $30 allowance | $0 copay | $30 allowance |
Lined bifocal | $20 copay | $50 allowance | $0 copay | $50 allowance |
Lined trifocal | $20 copay | $65 allowance | $0 copay | $65 allowance |
Lenticular | $20 copay | $100 allowance | $0 copay | $100 allowance |
Standard Lens Enhancement | ||||
Ultraviolet coating | Covered in Full | Applied to the allowance for the applicable corrective lens | Covered in Full | Applied to the allowance for the applicable corrective lens |
Polycarbonate (child up to age 18) | Covered in Full | Applied to the allowance | Covered in Full | Applied to the allowance for the applicable corrective lens |
Additional Lens Enhancements (1) | ||||
Progressive Standard | Up to $55 copay | $50 allowance | Up to $55 copay | $50 allowance |
Progressive Premium/Custom | Premium: Up to $95-$105 copay Custom: Up to $150-$175 copay | $50 allowance | Premium: Up to $95-$105 copay Custom: Up to $150-$175 copay | $50 allowance |
Polycarbonate (adult) | Single Vision: Up to $31 copay Multifocal: Up to $35 copay | Applied to the allowance for the applicable corrective lens | Single Vision: Up to $31 copay Multifocal: Up to $35 copay | Applied to the allowance for the applicable corrective lens |
Scratch-resistant coating (variable by type) | Up to $17 -$33 copay | Applied to the allowance for the applicable corrective lens | Up to $17-$33 copay | Applied to the allowance for the applicable corrective lens |
Tints (variable by type) | Single Vision: Up to $17-$34 copay Multifocal: Up to $17-$44 copay | Applied to the allowance for the applicable corrective lens | Single Vision: Up to $17-$34 copay Multifocal: Up to $17-$44 copay | Applied to the allowance for the applicable corrective lens |
Anti-reflective coating (variable by type) | Up to $41 -$85 copay | Applied to the allowance for the applicable corrective lens | Up to $41 -$85 copay | Applied to the allowance for the applicable corrective lens |
Photochromic (variable by type) | Up to $47 -$82 copay | Applied to the allowance for the applicable corrective lens | Up to $47 -$82 copay | Applied to the allowance for the applicable corrective lens |
Frame Allowance | ||||
Frame Allowance (You will receive an additional 20% off any amount that you pay over your allowance. This offer is available from all participating locations except Costco.) | $100 allowance | $55 allowance | $150 allowance | $70 allowance |
Costco | $55 allowance | $85 allowance | ||
Contact Lenses | ||||
Elective | $100 allowance | $80 allowance | $150 allowance | $105 allowance |
Necessary | Covered in full after eyewear copay | $210 allowance | Covered in full after eyewear copay | $210 allowance |
Contact Fitting and Evaluation | Standard or Premium fit: Covered in full with a maximum copay of $60 | Applied to the contact lens allowance | Standard or Premium fit: Covered in full with a maximum copay of $60 | Applied to the contact lens allowance |
Value Added Features | ||||
Additional Savings on Glasses and Sunglasses (1) | Get 20% off the cost for additional pairs of prescription glasses and non-prescription sunglasses, including lens enhancements. At times, other promotional offers may also be available. | |||
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. Offer is only available at MetLife participating locations. | |||
Frequency (Class Description: All Eligible Members) | ||||
Examinations | 1 per 12 Months | |||
Standard Corrective Lenses | 1 per 12 Months | |||
Frames | 1 per 24 Months-Low Plan; 1 per 12 Months-High Plan; | |||
Contact Lenses (Either glasses or contacts allowed per frequency) | 1 per 12 Months | |||
(1) Member costs for listed lens enhancements will be limited to copays that MetLife has negotiated with participating providers. These copays can be viewed by members after enrollment at www.metlife.com/mybenefits. All lens enhancements are available at participating private practices. Maximum copays and pricing are subject to change without notice. Please check with your provider for details and copays applicable to your lens choice. Please contact your local Costco to confirm the availability of lens enhancements and pricing prior to receiving services. Additional discounts may not be available in certain states. (3) Savings from enrolling in a MetLife vision benefits plan will depend on various factors including the cost of the plan, how often participants visit an eye-care professional and the cost of services and eyewear received. |