LM_SW_Benefits Guide 2024

Vision Plan Central National Gottesman Inc. offers a comprehensive vision benefit that covers exams and materials. Participating providers include both private practice doctors and retail chains such as Costco, LensCrafters, Pearle Vision, Sam’s Club, Visionworks, Walmart and more!

www.metlife.com/vision 833.393.5433

VISION PLAN

IN-NETWORK (METLIFE NATIONAL NETWORK)

BENEFIT

OUT-OF-NETWORK

Eye Exam Ophthalmologist Optometrist

$10 copay $10 copay

Up to $40 retail Up to $30 retail

Glasses (Frames and Lenses)

See below

Frequency Exam Eyeglass Lenses Frames Contact Lenses

12 months 12 months 24 months 12 months

12 months 12 months 24 months 12 months

Frames

$120 retail allowance 20% off the amount over your allowance

Up to $56 retail

Lenses Single Vision Lenses Bifocal Vision Lenses Trifocal Vision Lenses

$25 copay $25 copay $25 copay

Up to $28 retail Up to $42 retail Up to $57 retail

Contact Lenses* Medically Necessary Elective Contact Lens Fitting and Evaluation Standard Lenses Specialty Lenses**

Covered in Full $120 retail allowance $30 copay $30 copay (up to $50 allowance)

Up to $210 retail Up to $100 retail

N/A N/A

*Contact lenses are in lieu of eyeglass lenses and frames benefit. If contact lenses are purchased in addition to frames and lenses, you receive a 10% discount (only in network). If you go out of network, you will pay the full cost of the lenses. **The cost of specialty contact lens fitting and evaluation will vary by provider

You will receive an ID card once enrolled, but you do not need an ID card to receive benefits. You can also download a virtual card via MetLife’s mobile app. If you do not have your card on hand, you can provide your full name and date of birth to the participating doctor to access your benefits.

Log into www.workforcenow.adp.com and click on Resources – Company Information – Tools/Resources – 2024 Benefit Documents for details. In the event of a discrepancy, the carrier Plan Document shall prevail.

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QUESTIONS? Call BenefitsVIP ® at 866.286.5354