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)

VI-STAND Vision Benefit Summary 200 Park Ave., New York, NY 10166 © 2024 MetLife Services and Solutions, LLC L0423030985[exp0426][All States] Out-of-network reimbursement* You pay for services and then submit a claim for reimbursement. The same benefit frequencies for In-network benefits apply. Once you enroll, visit www.metlife.com/mybenefits for detailed out-of-network benefits information. • Eye exam: up to $45 • Single vision lenses: up to $30 • Progressive lenses: up to $50 • Frames: up to $70 • Lined bifocal lenses: up to $50 • Contact lenses: • Lined trifocal lenses: up to $65 • Elective up to $105 • Lenticular lenses: up to $100 • Necessary up to $210 • *If you choose an out-of-network provider, you will have increased out-of-pocket expenses, pay in full at time of service, and file a claim for reimbursement. 1. All lens enhancements are available at participating private practices. Maximum copays and pricing are subject to change without notice. Please check with your provider for details and copays applicable to your lens choice. Please contact your local Costco, Walmart or Sam’s Club to confirm availability of lens enhancements and pricing prior to receiving services. Additional discounts may not be available in certain states. 2. Custom LASIK coverage only available using wavefront technology with the microkeratome surgical device. Other LASIK procedures may be performed at an additional cost to the member. Additional savings on laser vision care is only available at participating locations. Important: If you or your family members are covered by more than one health care plan, you may not be able to collect benefits from both plans. Each plan may require you to follow its rules or use specific doctors and hospitals, and it may be impossible to comply with both plans at the same time. Before you enroll in this plan, read all of the rules very carefully and compare them with the rules of any other plan that covers you or your family. Savings from enrolling in a MetLife Vision Plan will depend on various factors, including plan premiums, number of visits to an eye care professional by your family per year and the cost of services and materials received. Be sure to review the Schedule of Benefits for your plan’s specific benefits and other important details. Vision insurance is provided by Metropolitan Life Insurance Company, New York, NY (MetLife). Certain claims and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. VSP is not affiliated with MetLife or its affiliates. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods, and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details.

VI-STAND Vision Benefit Summary 200 Park Ave., New York, NY 10166 © 2024 MetLife Services and Solutions, LLC L0423030985[exp0426][All States] Exclusions and Limitations of Benefits This plan does not cover the following services, materials and treatments: Services and Eyewear • Services and/or materials not specifically included in the Vision Plan Benefits Overview (Schedule of Benefits). • Any portion of a charge above the Maximum Benefit Allowance or reimbursement indicated in the Schedule of Benefits. • Any eye examination or corrective eyewear required as a condition of employment. • Services and supplies received by you or your Dependent before the Vision Insurance starts. • Missed appointments. • Services or materials resulting from or in the course of a Covered Person’s regular occupation for pay or profit for which the Covered Person is entitled to benefits under any Workers’ Compensation Law, Employer’s Liability Law or similar law. You must promptly claim and notify the Company of all such benefits. • Local, state and/or federal taxes, except where MetLife is required by law to pay. • Services or materials received as a result of disease, defect, or injury due to war or an act of war (declared or undeclared), taking part in a riot or insurrection, or committing or attempting to commit a felony. • Services and materials obtained while outside the United States, except for emergency vision care. • Services, procedures, or materials for which a charge would not have been made in the absence of insurance. • Services: (a) for which the employer of the person receiving such services is not required to pay; or (b) received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital. • Services, to the extent such services, or benefits for such services, are available under a Government Plan. This exclusion will apply whether or not the person receiving the services is enrolled for the Government Plan. We will not exclude payment of benefits for such services if the Government Plan requires that Vision Insurance under the Group Policy be paid first. Government Plan means any plan, program, or coverage which is established under the laws or regulations of any government. The term does not include any plan, program, or coverage provided by a government as an employer or Medicare. • Plano lenses (lenses with refractive correction of less than ± .50 diopter). • Two pairs of glasses instead of bifocals. • Replacement of lenses, frames and/or contact lenses, furnished under this Plan which are lost, stolen, or damaged, except at the normal intervals when Plan Benefits are otherwise available. • Contact lens insurance policies and service agreements. • Refitting of contact lenses after the initial (90 day) fitting period. • Contact lens modification, polishing, and cleaning. Treatments • Orthoptics or vision training and any associated supplemental testing. • Medical and surgical treatment of the eye(s). Medications • Prescription and non-prescription medication 1 All lens enhancements are available at participating private practices. Maximum copays and pricing are subject to change without notice. Please check with your provider for details and copays applicable to your lens choice. Please contact your local Costco, Walmart and Sam’s Club to confirm availability of lens enhancements and pricing prior to receiving services. Additional discounts may not be available in certain states. 2 Custom LASIK coverage only available using wavefront technology with the microkeratome surgical device. Other LASIK procedures may be performed at an additional cost to the member. Additional savings on laser vision care is only available at participating locations. Important: If you or your family members are covered by more than one health care plan, you may not be able to collect benefits from both plans. Each plan may require you to follow its rules or use specific doctors and hospitals, and it may be impossible to comply with both plans at the same time. Before you enroll in this plan, read all of the rules very carefully and compare them with the rules of any other plan that covers you or your family. M130A-10/25 MetLife Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY. Certain claims and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods, and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details.