Page 6 - Hanover Medical Management Sevices - 2022 Benefit Guide
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Vision Option:
MetLife
Rate Information
Per Pay Period Dependent Information
Employee Only $ 3.18 Hanover Medical Management Services, LLC offers
our employees the opportunity to cover their
Employee + Spouse $ 6.38 spouse or dependent children. Children can join or
remain on a parent’s vision plan until age 26. When
Employee + Child(ren) $ 5.40
a child turns 26, they will lose vision coverage on the
Employee + Family $ 8.91 last day of their birth month. This is an automated
process.
Benefits (In-Network) Plan Coverage
Copays:
Well Vision Exam $10 Copay
Materials $20 Copay
Contact Lens Exam (fitting and evaluation) Up to $60 Copay
Frequency: (January 1st through December 31st)
Exams Every 12 Months
Lenses Every 12 Months
Frames Every 24 Months
Contact Lenses Every 12 Months
Standard Lenses:
Single Vision Covered in Full after Copay
Lined Bifocal Covered in Full after Copay
Lined Trifocal Covered in Full after Copay
Standard Progressive Lenses $55 Copay
Premium Progressive Lenses $95 - $105 Copay
Custom Progressive Lenses $150 - $175 Copay
Frames:
Frames Allowance $150 Retail Allowance
Contact Lenses in lieu of eye glasses, materials only:
Frequency Every 12 Months
Lens Allowance $150 Retail Allowance
NOTE: This is only a brief overview. Please see Benefit Summary for more details.
Website: www.metlife.com or Customer Service : 855-638-3931
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