Archives: Cards & Charts
HSA Eligible
OPTION 1
Family
Your Monthly Premium
$2,382.33
Individual Deductible
$3,500
Individual Out-of-Pocket Max
$6,900
Family Deductible
$7,000
Family Out-of-Pocket Max
$13,800
Office Visit
20% After Deductible
Specialist Visit
20% After Deductible
Your Monthly Premium
$
Your Monthly Premium
$
MetLife Vision
Family
Your Monthly Premium
$18.19
Eye Exams
$10 Copay
Lenses Benefit (Single Vision)
$25 Copay
Frame Benefits
$130 Allowance
MetLife Vision
Primary + Child(ren)
Your Monthly Premium
$12.39
Eye Exams
$10 Copay
Lenses Benefit (Single Vision)
$25 Copay
Frame Benefits
$130 Allowance
MetLife Vision
Primary + Spouse
Your Monthly Premium
$11.80
Eye Exams
$10 Copay
Lenses Benefit (Single Vision)
$25 Copay
Frame Benefits
$130 Allowance
MetLife Vision
Primary Only
Your Monthly Premium
$6.18
Eye Exams
$10 Copay
Lenses Benefit (Single Vision)
$25 Copay
Frame Benefits
$130 Allowance
MetLife Dental
Primary Only
Your Monthly Premium
$33.02
Preventive
100%
Basic
80%
Major
50%
Annual Maximum (Per Person)
$1,500
Annual Deductible (Per Person)
$50
Annual Deductible (Family Maximum)
$150
MetLife Dental
Primary + Spouse
Your Monthly Premium
$75.25
Preventive
100%
Basic
80%
Major
50%
Annual Maximum (Per Person)
$1,500
Annual Deductible (Per Person)
$50
Annual Deductible (Family Maximum)
$150
MetLife Dental
Primary + Child(ren)
Your Monthly Premium
$86.04
Preventive
100%
Basic
80%
Major
50%
Annual Maximum (Per Person)
$1,500
Annual Deductible (Per Person)
$50
Annual Deductible (Family Maximum)
$150