Page 11 - MGM 2020 Benefits
P. 11
Vision Coverage
We partner with MetLife to offer you and your family members vision
insurance. Visit www.metlife.com to ind in-network providers and access
a variety of online tools and programs.
Find an In-Network Provider
Remember to visit in-network providers to receive the deepest level of
discount on your services. To ind a participating in-network provider in
your area, go to metlife.com or call one to have a list faxed to you.
In-Network Out-of-Network
Copay
Exam $10 copay Up to $45
Lenses
Single $25 copay Up to $30
Bifocal $25 copay Up to $50
Trifocal $25 copay Up to $65
Lenticular $25 copay Up to $100
Frames
$120 allowance Up to $105
Contacts (in lieu of glasses)
$120 allowance then 20% Up to $55
of amount over allowance
Frequency
Exam 12 months
Lenses 12 months
Contacts (in lieu of glasses) 12 months
Frames 24 months
This is a high level summary of your beneit coverage. Full coverage details are available in your
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
Employee Contributions—Semi-Monthly
Employee $3.15
Employee + Spouse $5.99
Employee + Child(ren) $6.30
Family $9.27
MGM Healthcare 11
We partner with MetLife to offer you and your family members vision
insurance. Visit www.metlife.com to ind in-network providers and access
a variety of online tools and programs.
Find an In-Network Provider
Remember to visit in-network providers to receive the deepest level of
discount on your services. To ind a participating in-network provider in
your area, go to metlife.com or call one to have a list faxed to you.
In-Network Out-of-Network
Copay
Exam $10 copay Up to $45
Lenses
Single $25 copay Up to $30
Bifocal $25 copay Up to $50
Trifocal $25 copay Up to $65
Lenticular $25 copay Up to $100
Frames
$120 allowance Up to $105
Contacts (in lieu of glasses)
$120 allowance then 20% Up to $55
of amount over allowance
Frequency
Exam 12 months
Lenses 12 months
Contacts (in lieu of glasses) 12 months
Frames 24 months
This is a high level summary of your beneit coverage. Full coverage details are available in your
summary plan description (SPD). In the event there is a discrepancy between what is relected in
this guide and what is communicated in your SPD, the terms of your SPD will prevail.
Employee Contributions—Semi-Monthly
Employee $3.15
Employee + Spouse $5.99
Employee + Child(ren) $6.30
Family $9.27
MGM Healthcare 11
