MetLife Vision

Primary + Spouse

Your Monthly Premium

$11.80

Eye Exams
$10 Copay
Lenses Benefit (Single Vision)
$25 Copay
Frame Benefits
$130 Allowance

Summary of Benefits

MetLife Critical Illness

Primary Only

Your Monthly Premium

$

Employee Coverage Options
$15,000 or $30,000

Summary of Benefits

MetLife Hospital Indemnity

Primary Only

Your Monthly Premium

$25.19

Admission Benefit
$1000
Confinement Benefit
$200
Inpatient Rehab Benefit
$100

Summary of Benefits

MetLife Vision

Primary Only

Your Monthly Premium

$6.18

Eye Exams
$10 Copay
Lenses Benefit (Single Vision)
$25 Copay
Frame Benefits
$130 Allowance

Summary of Benefits

MetLife Dental

Primary Only

Your Monthly Premium

$39.87

Preventive
100%
Basic
80%
Major
50%
Annual Maximum (Per Person)
$1,500
Annual Deductible (Per Person)
$50
Annual Deductible (Family Maximum)
$150

MetLife Non TX-MT-LA

MetLife Dental

Primary + Spouse

Your Monthly Premium

$90.86

Preventive
100%
Basic
80%
Major
50%
Annual Maximum (Per Person)
$1,500
Annual Deductible (Per Person)
$50
Annual Deductible (Family Maximum)
$150

MetLife Non TX-MT-LA

MetLife Dental

Primary + Child(ren)

Your Monthly Premium

$103.89

Preventive
100%
Basic
80%
Major
50%
Annual Maximum (Per Person)
$1,500
Annual Deductible (Per Person)
$50
Annual Deductible (Family Maximum)
$150

MetLife Non TX-MT-LA

MetLife Dental

Family

Your Monthly Premium

$156.09

Preventive
100%
Basic
80%
Major
50%
Annual Maximum (Per Person)
$1,500
Annual Deductible (Per Person)
$50
Annual Deductible (Family Maximum)
$150

MetLife Non TX-MT-LA

OPTION 1

Primary Only

Your Monthly Premium

$1,047.33

Individual Deductible
N/A for no cost services
Individual Out-of-Pocket Max
$6,000
Family Deductible
$12,000
Family Out-of-Pocket Max
$12,000
Office Visit
No charge
Specialist Visit
No charge

OPTION 1

Primary + Spouse

Your Monthly Premium

$2,199.46

Individual Deductible
N/A for no cost services
Individual Out-of-Pocket Max
$6,000
Family Deductible
$12,000
Family Out-of-Pocket Max
$12,000
Office Visit
No charge
Specialist Visit
No charge