Page 12 - First Presbyterian Church Benefit Guide

Vision Plan

MetLife | Vision Plan
FCPH 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 VSP 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

Tier Payroll Deduction
Employee Only $0.00
Employee + Spouse $4.45
Employee + Child(ren) $3.09
Employee + Family $7.96

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.

12 Employee Benefits