Page 18 - Impact Floors 2022 Benefit Guide

Voluntary Vision plan

The vision plan provides coverage for routine eye exams and pays for all or a portion of the cost of glasses or contact lenses.
You can choose any provider; however, you always save money if you see in-network providers. We offer a vision plan through MetLife.

MetLife Vision PPO
Plan Provision In-Network Out-of-Network*

Exam $10 copay Up to $45 off
$130 allowance plus
Frames 20% off balance over $130; Up to $70 off
$70 allowance at Costco
Lenses
 Single vision lenses $25 copay Up to $30 off
 Bifocal lenses $25 copay Up to $50 off
 Trifocal lenses $25 copay Up to $65 off
Contact Lenses
 Elective $130 allowance Up to $105 off
 Medically necessary No charge Up to $210 off
Frequency
 Exam 12 Months 12 Months
 Lenses 12 Months 12 Months
 Frames 24 Months 24 Months
 Contact lenses 12 Months 12 Months
*Out-of-Network benefits are shown as provider reimbursements before the copay is applied.

Your payroll contributions for medical benefits are shown here.

MetLife Vision PPO
Coverage Level Semi-Monthly Bi-Weekly Weekly
Employee Only $3.77 $3.48 $1.74
Employee + Spouse $7.56 $6.97 $3.49
Employee + Child(ren) $6.40 $5.90 $2.95
Family $10.55 $9.73 $4.87

18