VSP Choice

VI-STAND Vision Benefit Summary 200 Park Ave., New York, NY 10166 © 2024 MetLife Services and Solutions, LLC L0423030985[exp0426][All States] VSP Choice Network Plan Summary Metropolitan Life Insurance Company With your Vision Preferred Provider Organization Plan, you can: •Go to any licensed vision specialist and receive coverage. Just remember your benefit dollars go further when you stay in network. •Choose from a large network of ophthalmologists, optometrists and opticians, from private practices to retailers like Costco® Optical, Walmart, Sam’s Club and Visionworks. In-network value added features: Additional lens enhancements: In addition to standard lens enhancements, enjoy an average 20-25% savings on all other lens enhancements.1 Savings on glasses and sunglasses: Get up to 20% savings on additional pairs of prescription glasses and non-prescription sunglasses, including lens enhancements. At times, other promotional offers may also be available.1 Laser vision correction: 2 Potential savings averaging 15% off the regular price or 5% off a promotional offer for laser surgery including PRK, LASIK and Custom LASIK. This offer is only available at MetLife participating locations. In-network benefits There are no claims for you to file when you go to a participating vision provider. Simply pay your copay and, if applicable, any amount over your allowance at the time of service. Frequency Eye exam Once every 12 months • Eye health exam, dilation, prescription and refraction for glasses: At no additional cost after a $10 copay. • Retinal imaging: At no additional cost Up to a $39 copay on routine retinal screening when performed by a private practice provider. Frame Once every 12 months • Allowance: $130 after $25 eyewear copay. • Costco, Walmart and Sam’s Club: $70 allowance after $25 eyewear copay. You will receive an additional 20% savings on the amount that you pay over your allowance. This offer is available from all participating locations except Costco, Walmart and Sam’s Club. Standard corrective lenses Once every 12 months • Single vision, lined bifocal, lined trifocal, lenticular: At no additional cost after $25 eyewear copay. Standard lens enhancements1 Once every 12 months • Polycarbonate (child up to age 18) and Ultraviolet (UV) coating: At no additional cost after $25 . eyewear copay. • Progressive Standard, Progressive Premium/Custom, Polycarbonate (adult), Photochromic, Anti-reflective, Scratch-resistant coatings and Tints: Your cost will be limited to a copay that MetLife has negotiated for you. These copays can be viewed after enrollment at www.metlife.com/mybenefits. Contact lenses instead of eye glasses Once every 12 months • Contact fitting and evaluation: At no additional cost with a maximum copay of $60. • Elective lenses: $130 allowance. • Necessary lenses: At no additional cost after eyewear copay. We’re here to help Find a Vision provider at www.metlife.com/vision Download a claim form at www.metlife.com/mybenefits For general questions go to www.metlife.com/mybenefits or call 1-855-MET-EYE1 (1-855-638-3931)