Page 8 - 2024 Hanover Medical Management Sevices Benefit Guide - EN Revised

Vision Option:

MetLife

Rate Information
Per Pay Period Dependent Information

Employee Only $ 3.45 Hanover Medical Management Services, LLC offers
our employees the opportunity to cover their
Employee + Spouse $ 6.90 spouse or dependent children. Children can join or

remain on a parent’s vision plan until age 26. When
Employee + Child(ren) $ 5.85
a child turns 26, they will lose vision coverage on the
Employee + Family $ 9.64 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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