Page 11 - Asian Box Guide FINAL 9.11

Vision Plan

MetLife | Vision Plan
Asian Box provides vision coverage through MetLife. You can see an MetLife in-network provider or an out-of-network provider,
however, your costs will be lower if you visit an in-network provider. If you visit an in-network provider you will be responsible for
a copayment at the time of your service. If you receive services from an out-of-network doctor, you will pay all costs at the time of
service and submit a claim for reimbursement.

MetLife
Plan Name PPO

Network Name PDP Plus Network Non-Network
Vision Benefits

Copay
- Examination $10 Copay N/A
- Materials $25 Copay N/A
Examination (Every 12 Months) No Charge Up to $45 Reimbursement
Lenses (Every 12 Months)
- Single Vision No Charge Up to $30 Reimbursement
- Bifocal No Charge Up to $50 Reimbursement
- Trifocal No Charge Up to $65 Reimbursement
Frames (Every 24 Months) $130 Benefit Up to $70 Reimbursement
Contact Lenses (Every 12 Months) (in lieu of frames and lenses)

- Cosmetic / Elective $130 Benefit Up to $105 Reimbursement
- Medically Necessary No Charge Up to $210 Reimbursement

Laser Vision Correction Discounts Apply Not Covered

Finding a Vision Provider
Go to www.metlife.com/insurance/vision-insurance or call (855) 638-3931

The MetLife Vision network includes access to independent ophthalmologists and optometrists. Choose
from a large network of ophthalmologists, optometrists and opticians, from private practices to retailers like
Costco Optical, Walmart, Sam’s Club and Visionworks.

MetLaw | Legal Plan
The Legal Plan from MetLaw gives you a place to turn to help address and resolve life’s legal or financial issues – from disputing a
contractor’s charges, to preparing a will, to receiving a traffic ticket. You’ll have access to a network of attorneys who can, work
with you in-person, over the phone or online to consult with you on legal issues, review and prepare documents, make follow-up
calls or write letters on your behalf, represent you if needed, and more.

This plan does not cover divorce, DUIs or employment-related matters. You may visit the Covered Services section by visiting
https://info.legalplans.com/Home/ to view examples of covered legal matters.

Payroll deductions are $19.50 per employee per month which covers spouse and dependents.

Employee Benefits 11