Page 11 - Burlingame EE Guide 12-19 - English

BENEFITS

Vision Insurance

MetLife | PPO Vision Plan
The MetLife plan provides professional vision care and high quality lenses and frames through a broad network of optical
specialists. You will receive richer benefits if you utilize a network provider. If you utilize a non‐network provider, you will be
responsible to pay all charges at the time of your appointment and will be required to file an itemized claim with MetLife.

MetLife Note
Plan Name PPO Plan MetLife uses the
Network Network Non-Network VSP network. This
includes access to
Vision Benefits independent
ophthalmologists
Examination (Every 12 Months) $10 Copay Up to $45 Allowance
and optometrists, as
Lenses (Every 12 Months) $25 Copay well as Costco,
- Single Vision No Charge after Copay Up to $30 Allowance Pearle Vision, Sam's
- Bifocal No Charge after Copay Up to $50 Allowance Club, Wal-mart,
- Trifocal No Charge after Copay Up to $65 Allowance Fred Meyer,
- Progressive Standard No Charge after Copay Up to $50 Allowance Nationwide Vision,
- Ultraviolet Coating No Charge after Copay Applied to the allowance for and Optical inside
the applicable corrective lens CVS pharmacy.
- Anti-Reflective Coating Up to $41-$85 Copay Applied to the allowance for
the applicable corrective lens
Frames (Every 12 Months)
- Retail Up to $100 allowance Up to $55 Allowance
- Costco Up to $55 allowance
Contact Lenses (Every 12 Months) In Lieu of Frames and Lenses

- Cosmetic / Elective Up to $100 allowance Up to $80 Allowance
- Medically Necessary Covered in full after Copay Up to $210 Allowance

Get 20% off the cost of an additional pair of prescription glasses and non-prescription sunglasses, including lens enhancements as
a member. Savings averaging 15% off the regular price of laser eye surgery.

Finding a Vision Provider
Call (855) 638-3931 or go to www.metlife.com/mybenefits.

Employee Assistance Program

Mutual of Omaha | Employee Assistance Program
The Employee Assistance Program (EAP) through Mutual of Omaha provides you and your household members with free,
confidential assistance to help with personal or professional problems that may interfere with work or family responsibilities and
obligations. Services are available 24 hours a day, 7 days a week via a toll-free nationwide number. You and your household
members can receive up to 3 counseling sessions per person, per problem, per year.

Accessing the EAP
Call (800) 316-2796 or go to www.mutualofomaha.com/eap (ID: Burlingame Industries).

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