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raunakdoesdev/metlife_output.json

Created May 23, 2024 02:31
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metlife_output.json
{
"usage": {
"num_pages": 63,
"num_fields": 1098
},
"result": [
{
"companyName": "MetLife",
"effectiveDate": null,
"benefitPlans": [
{
"planName": "Basic Life and AD&D",
"rates": {
"rateTables": [
{
"rateGuarantee": "2023-01-01 - 2024-12-31",
"rows": [
{
"description": "Basic Life (per $1,000 of Covered Volume)",
"lives": 89,
"monthlyRate": 0.06,
"estimatedAnnualCost": 638
},
{
"description": "Basic AD&D (per $1,000 of Covered Volume)",
"lives": 89,
"monthlyRate": 0.014,
"estimatedAnnualCost": 149
}
]
}
]
},
"coveredServices": []
},
{
"planName": "Supplemental Life and AD&D",
"rates": {
"rateTables": [
{
"rateGuarantee": "2023-01-01 - 2024-12-31",
"rows": [
{
"description": "Less than 30",
"lives": 6,
"monthlyRate": 0.055
},
{
"description": "30-34",
"lives": 12,
"monthlyRate": 0.06
},
{
"description": "35-39",
"lives": 4,
"monthlyRate": 0.078
},
{
"description": "40-44",
"lives": 1,
"monthlyRate": 0.113
},
{
"description": "45-49",
"lives": 2,
"monthlyRate": 0.175
},
{
"description": "50-54",
"lives": 1,
"monthlyRate": 0.283
},
{
"description": "55-59",
"lives": 1,
"monthlyRate": 0.434
},
{
"description": "60-64",
"lives": 1,
"monthlyRate": 0.665
},
{
"description": "65-69",
"lives": 1,
"monthlyRate": 1.127
},
{
"description": "70+",
"lives": 0,
"monthlyRate": 2.12
}
]
}
]
},
"coveredServices": []
},
{
"planName": "Supplemental Dependent Life",
"rates": {
"rateTables": [
{
"rateGuarantee": "2023-01-01 - 2024-12-31",
"rows": [
{
"description": "Less than 30",
"monthlyRate": 0.055
},
{
"description": "30-34",
"monthlyRate": 0.06
},
{
"description": "35-39",
"monthlyRate": 0.078
},
{
"description": "40-44",
"monthlyRate": 0.113
},
{
"description": "45-49",
"monthlyRate": 0.175
},
{
"description": "50-54",
"monthlyRate": 0.283
},
{
"description": "55-59",
"monthlyRate": 0.434
},
{
"description": "60-64",
"monthlyRate": 0.665
},
{
"description": "65-69",
"monthlyRate": 1.127
},
{
"description": "70+",
"monthlyRate": 2.12
},
{
"description": "Child",
"monthlyRate": 0.24
}
]
}
]
},
"coveredServices": []
},
{
"planName": "Supplemental Dependent AD&D",
"rates": {
"rateTables": [
{
"rateGuarantee": "2023-01-01 - 2024-12-31",
"rows": [
{
"description": "Spouse",
"monthlyRate": 0.014
},
{
"description": "Child(ren)",
"monthlyRate": 0.048
}
]
}
]
},
"coveredServices": []
},
{
"planName": "Voluntary Dental - High/Low PPO",
"rates": {
"rateTables": [
{
"rateGuarantee": "2023-01-01 - 2023-12-31",
"rows": [
{
"description": "Employee Only",
"lives": 20,
"monthlyRate": 44.72,
"estimatedAnnualCost": 24921
},
{
"description": "Employee + Spouse",
"lives": 3,
"monthlyRate": 89.19
},
{
"description": "Employee + Child(ren)",
"lives": 3,
"monthlyRate": 99.47
},
{
"description": "Employee + Family",
"lives": 4,
"monthlyRate": 154.09
},
{
"description": "Employee Only",
"lives": 30,
"monthlyRate": 38.58,
"estimatedAnnualCost": 29838
},
{
"description": "Employee + Spouse",
"lives": 5,
"monthlyRate": 76.95
},
{
"description": "Employee + Child(ren)",
"lives": 4,
"monthlyRate": 79.41
},
{
"description": "Employee + Family",
"lives": 5,
"monthlyRate": 125.34
}
]
}
]
},
"coveredServices": []
},
{
"planName": "Vision - PPO",
"rates": {
"rateTables": [
{
"rateGuarantee": "2023-01-01 - 2024-12-31",
"rows": [
{
"description": "Employee Only",
"lives": 50,
"monthlyRate": 7.98,
"estimatedAnnualCost": 8633
},
{
"description": "Employee + Spouse",
"lives": 6,
"monthlyRate": 16.01
},
{
"description": "Employee + Child(ren)",
"lives": 5,
"monthlyRate": 13.56
},
{
"description": "Employee + Family",
"lives": 7,
"monthlyRate": 22.36
}
]
}
]
},
"coveredServices": []
},
{
"planName": "Short Term Disability",
"rates": {
"rateTables": [
{
"rateGuarantee": "2023-01-01 - 2024-12-31",
"rows": [
{
"description": "Short Term Disability (per $10 Covered Weekly Benefit)",
"lives": 89,
"monthlyRate": 0.071,
"estimatedAnnualCost": 9437
}
]
}
]
},
"coveredServices": []
},
{
"planName": "Long Term Disability",
"rates": {
"rateTables": [
{
"rateGuarantee": "2023-01-01 - 2024-12-31",
"rows": [
{
"description": "Long Term Disability (per $100 Covered Monthly Payroll)",
"lives": 89,
"monthlyRate": 0.085,
"estimatedAnnualCost": 8011
}
]
}
]
},
"coveredServices": []
},
{
"planName": "Basic Life",
"rates": {
"rateTables": [
{
"rateGuarantee": "Not included",
"rows": [
{
"description": "Flat $10,000 for all active full-time employees (30 hours)",
"estimatedAnnualCost": 0
}
]
}
]
},
"coveredServices": [
{
"category": "Life Insurance",
"services": [
{
"serviceName": "Basic Life Coverage",
"details": [
{
"description": "Flat $10,000 coverage for all active full-time employees",
"benefit": "$10,000"
},
{
"description": "Medical Evidence Level",
"benefit": "$10,000"
},
{
"description": "Age reductions apply to the original benefit amount"
},
{
"description": "Extended Death Benefits",
"benefit": "Included"
},
{
"description": "Conversion and Portability",
"benefit": "Included"
},
{
"description": "Accelerated Benefit Option",
"benefit": "Not included"
}
]
}
]
}
]
},
{
"planName": "Basic Life / AD&D Insurance - Flat $10K",
"rates": {
"rateTables": [
{
"rateGuarantee": "January 1, 2023 - December 31, 2024 (24 months)",
"rows": [
{
"description": "Basic Life",
"monthlyRate": 0.06,
"estimatedMonthlyCost": 53,
"estimatedAnnualCost": 638
},
{
"description": "Basic AD&D",
"monthlyRate": 0.014,
"estimatedMonthlyCost": 12,
"estimatedAnnualCost": 149
}
]
}
]
},
"coveredServices": [
{
"category": "Basic AD&D",
"services": [
{
"serviceName": "All Active Full Time Employees (30 Hours)",
"details": [
{
"description": "100% of the Basic Life benefit.",
"coveredFor": "All Active Full Time Employees"
},
{
"description": "Extended Death Benefits",
"coveredFor": "All Active Full Time Employees"
},
{
"description": "Portability is included in this quote",
"coveredFor": "All Active Full Time Employees"
}
]
}
]
}
]
},
{
"planName": "Life / AD&D Insurance - Flat $10K",
"coveredServices": [
{
"category": "Plan Features and Limitations",
"services": [
{
"serviceName": "Portability",
"details": [
{
"description": "Option to continue term insurance under a different policy when coverage terminates. Minimums, maximums, and other conditions apply.",
"coveredFor": "Not available for residents of Alaska"
}
]
},
{
"serviceName": "Grief Counseling",
"details": [
{
"description": "Automatically included with Basic Life at no additional cost to the employer or employee. Available in all situs states on Basic Life except ND.",
"coveredFor": "Basic Life"
},
{
"description": "Automatically included with Supplemental Life at no additional cost to the employee. Available in all situs states on Supplemental Life except for FL and ND.",
"coveredFor": "Supplemental Life"
},
{
"description": "Grief counseling provides eligible beneficiaries a form of counseling that aims to help people cope with grief and mourning following the death of a loved one.",
"benefit": "Grief counseling is offered by LifeWorks US Inc. Services are provided through an agreement with LifeWorks US Inc., which is not an affiliate of MetLife and the services provided are separate and apart from the insurance provided by MetLife."
}
]
}
]
}
]
},
{
"planName": "Life / AD&D Insurance - Flat $10K",
"coveredServices": [
{
"category": "Funeral Discounts and Planning Services",
"services": [
{
"serviceName": "Funeral, Cremation, and Cemetery Services",
"details": [
{
"description": "Access to discounts of up to 10% off through the largest network of funeral homes and cemeteries in the United States.",
"coveredFor": "MetLife group life policyholders and their families"
},
{
"description": "Convenient planning services available online, by phone, or by paper.",
"coveredFor": "MetLife group life policyholders and their families"
},
{
"description": "Assistance from compassionate funeral planning experts for confident decision-making and bereavement travel services available 24/7/365.",
"coveredFor": "MetLife group life policyholders and their families"
}
]
}
]
}
]
},
{
"planName": "Life / AD&D Insurance - Flat $10K",
"rates": {},
"coveredServices": [
{
"category": "Total Control Account (TCA)",
"services": [
{
"serviceName": "TCA Settlement Option",
"details": [
{
"description": "Payment under the policy may be accomplished by placing the full amount of death claim proceeds into a TCA, an interest-bearing account with draft-writing privileges, and providing the beneficiary with a book of drafts. Beneficiary also receives a Customer Agreement and other materials describing the TCA.",
"benefit": "Relieves beneficiaries of the need to make immediate decisions about what to do with a settlement check, while giving them the flexibility to access funds as needed and earn interest on the proceeds as they assess their financial situation.",
"coveredFor": "Beneficiary"
},
{
"description": "Beneficiary can access the full amount of death proceeds, including any accrued interest, at any time by writing a single draft or several drafts for smaller amounts (as little as $250). There are no limits on the number of drafts the beneficiary can write. Processing time is similar to check processing.",
"coveredFor": "Beneficiary"
},
{
"description": "Beneficiary may request a fee-free Visa debit card. Any fees the beneficiary incurs using the TCA debit card are credited right back to the account.",
"coveredFor": "Beneficiary"
},
{
"description": "Beneficiary has the ability to link the account to popular payment apps/services such as PayPal®, Venmo or Square Cash",
"coveredFor": "Beneficiary"
},
{
"description": "Beneficiary may transfer funds from the TCA at any time without fees through ACH and bank to bank wires.",
"coveredFor": "Beneficiary"
},
{
"description": "Recordkeeping and draft clearing services for your TCA are provided by BNY Mellon Bank, 701 Market Street, Philadelphia, PA 19106.",
"coveredFor": "Beneficiary"
},
{
"description": "Beneficiary may also move all or a portion of the TCA balance (subject to applicable minimums) into any other settlement option for which he/she then qualifies.",
"coveredFor": "Beneficiary"
},
{
"description": "The account begins to earn interest from day one. The interest rate on the account will never be lower than the Guaranteed Minimum Rate of .50%.",
"coveredFor": "Beneficiary"
},
{
"description": "Principal and interest earned are backed by the financial strength and claims paying ability of MetLife.",
"coveredFor": "Beneficiary"
},
{
"description": "No monthly maintenance fees, no ATM fees, or charges for writing drafts, reordering drafts or making withdrawals. Charges may apply for an overdrawn TCA or special services. The current fees (subject to change) for those services are: draft copy $2; stop payment $10; overdrawn TCA $15; overnight delivery service $25.",
"coveredFor": "Beneficiary"
},
{
"description": "Every quarter, we'll send the beneficiary a personalized statement of the account detailing any activity since the previous quarter. The beneficiary will also receive statements for any months where there has been activity on the account. The statements will be sent via postal mail or electronically.",
"coveredFor": "Beneficiary"
},
{
"description": "Additional information about the TCA and account services is available electronically through MetLife's easy to use MetOnline web site.",
"coveredFor": "Beneficiary"
},
{
"description": "Dedicated US-based Customer Service Representatives specially trained to provide service to beneficiaries are also available through a special toll-free number (800-638-7283).",
"coveredFor": "Beneficiary"
},
{
"description": "Through MetLife's automated phone system, Accountholders are able to touch or speak their requests into the phone such as, \"hear account balance\", \"get recent transactions\", and \"order drafts.\"",
"coveredFor": "Beneficiary"
},
{
"description": "Beneficiary may also may conveniently use the TCA as a source of funds to pay bills online or by phone (no minimum payment amount), and link to his or her favorite mobile payment service.",
"coveredFor": "Beneficiary"
}
]
}
]
}
]
},
{
"planName": "Life / AD&D Insurance - Flat $10K",
"rates": {
"rateTables": [
{
"rateGuarantee": "Final rates will be based on actual enrollment and contribution levels.",
"rows": [
{
"description": "Broker Commissions",
"monthlyRate": 10
},
{
"description": "Expected Participation",
"lives": 100
},
{
"description": "Employee Contributions",
"monthlyRate": 0
}
]
}
]
},
"coveredServices": [
{
"category": "General Provisions",
"services": [
{
"serviceName": "Situs",
"details": [
{
"description": "State",
"benefit": "CALIFORNIA"
}
]
},
{
"serviceName": "Financial Arrangement",
"details": [
{
"description": "Type",
"benefit": "Non-retrospectively Experience Rated"
}
]
},
{
"serviceName": "Enrollment Materials Submission",
"details": [
{
"description": "Deadline",
"benefit": "Submit complete enrollment materials by the 15th of the month preceding the effective date to ensure prompt Underwriting review."
}
]
},
{
"serviceName": "Benefits Termination",
"details": [
{
"description": "Applicable To",
"benefit": "Benefits terminate at retirement for: Basic Life Basic AD&D"
},
{
"description": "AD&D Benefits Termination",
"benefit": "AD&D Benefits terminate when the corresponding Life Benefits terminate."
}
]
}
]
}
]
},
{
"planName": "Life / AD&D Insurance - Flat $10K",
"rates": {},
"coveredServices": [
{
"category": "Actively at Work Provisions",
"services": [
{
"serviceName": "Transition Rules Coverage",
"details": [
{
"description": "All Employees covered under transition rules regardless of Actively At Work status, if covered by prior plan day before MetLife effective date and no Waiver of Premium claim approved by prior carrier.",
"benefit": "Coverage equal to lesser of prior plan or MetLife plan amounts for employee class and coverage type"
},
{
"description": "Transition coverage continues until earliest of: return to work as Full-Time Employee, end of 12 month period post-MetLife effective date, date coverage would have ceased under prior policy, or termination provisions of MetLife certificate.",
"benefit": "Extension protection under Waiver of Premium provision of prior carrier's policy"
}
]
}
]
}
]
},
{
"planName": "Supplemental Term Life",
"rates": {},
"coveredServices": [
{
"category": "Eligibility",
"services": [
{
"serviceName": "Eligibility Criteria",
"details": [
{
"description": "All Active Full Time Employees (30 Hours)",
"benefit": "Eligible"
}
]
}
]
},
{
"category": "Coverage",
"services": [
{
"serviceName": "Incremental Coverage",
"details": [
{
"description": "$10,000 increments to a maximum of the lesser of 5.00 times pay or $500,000",
"benefit": "Up to $500,000"
}
]
},
{
"serviceName": "Minimum Benefit",
"details": [
{
"description": "A minimum benefit of $10,000",
"benefit": "$10,000"
}
]
},
{
"serviceName": "Medical Evidence Level",
"details": [
{
"description": "Medical Evidence Level",
"benefit": "$100,000"
}
]
},
{
"serviceName": "Age Reduction",
"details": [
{
"description": "No Age Reduction",
"benefit": "None"
}
]
},
{
"serviceName": "Waiver of Premium",
"details": [
{
"description": "disabled prior to 60, waiting period 9 months, coverage continues to 65",
"benefit": "Until age 65"
}
]
},
{
"serviceName": "Conversion and Portability",
"details": [
{
"description": "Conversion and Portability are included in this quote",
"benefit": "Included"
}
]
},
{
"serviceName": "Accelerated Benefit Option",
"details": [
{
"description": "12 months or less to live, up to 80.0% of coverage, to a maximum of $500,000",
"benefit": "Up to 80% of coverage, max $500,000"
}
]
}
]
}
]
},
{
"planName": "Supplemental Term AD&D",
"rates": {
"rateTables": [
{
"rateGuarantee": "January 1, 2023 - December 31, 2024 (24 months)",
"rows": [
{
"description": "Less than 30",
"monthlyRate": 0.055,
"estimatedMonthlyCost": 1258,
"estimatedAnnualCost": 15101
},
{
"description": "30-34",
"monthlyRate": 0.06
},
{
"description": "35-39",
"monthlyRate": 0.078
},
{
"description": "40-44",
"monthlyRate": 0.113
},
{
"description": "45-49",
"monthlyRate": 0.175
},
{
"description": "50-54",
"monthlyRate": 0.283
},
{
"description": "55-59",
"monthlyRate": 0.434
},
{
"description": "60-64",
"monthlyRate": 0.665
},
{
"description": "65-69",
"monthlyRate": 1.127
},
{
"description": "70+",
"monthlyRate": 2.12
}
]
}
]
},
"coveredServices": [
{
"category": "Supplemental Term AD&D Benefits",
"services": [
{
"serviceName": "Waiver of Premium",
"details": [
{
"description": "Disabled prior to age 60",
"benefit": "Coverage continues to age 65",
"frequency": "Waiting period 9 months"
}
]
},
{
"serviceName": "Portability",
"details": [
{
"description": "Included in this quote"
}
]
}
]
}
]
},
{
"planName": "Supplemental Dependent Life",
"rates": {
"rateTables": [
{
"rateGuarantee": "January 1, 2023 - December 31, 2024",
"rows": [
{
"description": "Less than 30",
"monthlyRate": 0.055
},
{
"description": "30-34",
"monthlyRate": 0.06
},
{
"description": "35-39",
"monthlyRate": 0.078
},
{
"description": "40-44",
"monthlyRate": 0.113
},
{
"description": "45-49",
"monthlyRate": 0.175
},
{
"description": "50-54",
"monthlyRate": 0.283
},
{
"description": "55-59",
"monthlyRate": 0.434
},
{
"description": "60-64",
"monthlyRate": 0.665
},
{
"description": "65-69",
"monthlyRate": 1.127
},
{
"description": "70+",
"monthlyRate": 2.12
},
{
"description": "Child",
"monthlyRate": 0.24
}
]
}
]
},
"coveredServices": [
{
"category": "Spouse Benefit",
"services": [
{
"serviceName": "Spouse Benefit",
"details": [
{
"description": "Increments of $5,000 to a maximum of $100,000, not to exceed 50% of employee's Optional Life Benefit",
"benefit": "$5,000 increments",
"frequency": "A minimum benefit of $5,000"
},
{
"description": "Medical Evidence Level",
"benefit": "$25,000"
},
{
"description": "Accelerated Benefit Option",
"benefit": "Up to 80.0% of coverage, to a maximum of $500,000",
"frequency": "12 months or less to live"
}
]
}
]
},
{
"category": "Child Benefit",
"services": [
{
"serviceName": "Child Benefit",
"details": [
{
"description": "Under 15 days",
"benefit": "$100"
},
{
"description": "15 days to 6 months old",
"benefit": "$1,000"
},
{
"description": "More than 6 months old",
"benefit": "Options of $1,000, $2,000, $4,000, $5,000 or $10,000."
},
{
"description": "Limiting age",
"benefit": "26, 26 if a full time student"
},
{
"description": "Medical Evidence Level",
"benefit": "$10,000"
}
]
}
]
}
]
},
{
"planName": "Supplemental Dependent AD&D",
"rates": {
"rateTables": [
{
"rateGuarantee": "January 1, 2023 - December 31, 2024",
"rows": [
{
"description": "Spouse",
"monthlyRate": 0.014
},
{
"description": "Child",
"monthlyRate": 0.048
}
]
}
]
},
"coveredServices": [
{
"category": "Spouse Benefit",
"services": [
{
"serviceName": "Spouse Benefit",
"details": [
{
"description": "100% of the Dependent Supplemental Life benefit.",
"benefit": "100%"
}
]
}
]
},
{
"category": "Child Benefit",
"services": [
{
"serviceName": "Child Benefit",
"details": [
{
"description": "Under 15 days",
"benefit": "$100"
},
{
"description": "15 days to 6 months old",
"benefit": "$1,000"
},
{
"description": "More than 6 months old",
"benefit": "Options of $1,000, $2,000, $4,000, $5,000 or $10,000."
}
]
}
]
}
]
},
{
"planName": "Supplemental Life and AD&D",
"coveredServices": [
{
"category": "Plan Features and Limitations",
"services": [
{
"serviceName": "Portability",
"details": [
{
"description": "Option to continue term insurance under a different policy when coverage terminates. Minimums, maximums, and other conditions apply. Portability is not available for residents of Alaska."
}
]
},
{
"serviceName": "Grief Counseling",
"details": [
{
"description": "Automatically included with Basic Life at no additional cost to the employer or employee. Available in all situs states on Basic Life except ND. Automatically included with Supplemental Life at no additional cost to the employee. Available in all situs states on Supplemental Life except for FL and ND.",
"benefit": "Grief counseling is offered by LifeWorks US Inc. Provides eligible beneficiaries a form of counseling to help cope with grief and mourning following the death of a loved one. Services are provided through an agreement with LifeWorks US Inc., which is not an affiliate of MetLife and the services provided are separate and apart from the insurance provided by MetLife."
}
]
},
{
"serviceName": "Will Preparation",
"details": [
{
"description": "Automatically included with Supplemental Life. Face to Face meeting with a MetLife Legal Plans attorney.",
"benefit": "Offered by MetLife Legal Plans, Inc., Cleveland, Ohio. In certain states, legal services benefits are provided through insurance coverage underwritten by Metropolitan Property and Casualty Insurance Company and Affiliates, Warwick, Rhode Island. For New York sitused cases, includes office consultations and telephone advice for certain other legal matters beyond Will Preparation."
}
]
},
{
"serviceName": "MetLife Estate Resolution Services",
"details": [
{
"description": "Automatically included with Supplemental Life. Face to Face meeting with a MetLife Legal Plans attorney.",
"benefit": "Offered by MetLife Legal Plans, Inc., Cleveland, Ohio. In certain states, legal services benefits are provided through insurance coverage underwritten by Metropolitan Property and Casualty Insurance Company and Affiliates, Warwick, Rhode Island."
}
]
}
]
}
]
},
{
"planName": "Supplemental Life and AD&D",
"rates": {},
"coveredServices": [
{
"category": "Funeral Discounts and Planning Services",
"services": [
{
"serviceName": "Funeral, Cremation, and Cemetery Services",
"details": [
{
"description": "Access to discounts of up to 10% off through the largest network of funeral homes and cemeteries in the United States.",
"coveredFor": "MetLife group life policyholder and family"
}
]
},
{
"serviceName": "Planning Services",
"details": [
{
"description": "Convenient planning services available online, by phone, or by paper to help manage final wishes.",
"coveredFor": "MetLife group life policyholder and family"
}
]
},
{
"serviceName": "Bereavement Travel Services",
"details": [
{
"description": "Assistance with time-sensitive travel arrangements to be with loved ones, available 24/7/365.",
"coveredFor": "MetLife group life policyholder and family"
}
]
},
{
"serviceName": "Expert Funeral Planning Assistance",
"details": [
{
"description": "Access to compassionate funeral planning experts to guide in making confident decisions.",
"coveredFor": "MetLife group life policyholder and family"
}
]
}
]
}
]
},
{
"planName": "Supplemental Life and AD&D",
"rates": {},
"coveredServices": [
{
"category": "Total Control Account (TCA)",
"services": [
{
"serviceName": "TCA Settlement Option",
"details": [
{
"description": "Payment under the policy may be accomplished by placing the full amount of death claim proceeds into a TCA, an interest-bearing account with draft-writing privileges, and providing the beneficiary with a book of drafts. Beneficiary also receives a Customer Agreement and other materials describing the TCA.",
"benefit": "Full amount of death claim proceeds"
}
]
},
{
"serviceName": "Access to Funds",
"details": [
{
"description": "Beneficiary can access the full amount of death proceeds, including any accrued interest, at any time by writing a single draft or several drafts for smaller amounts (as little as $250).",
"benefit": "Full amount of death proceeds"
}
]
},
{
"serviceName": "Fee-free Visa Debit Card",
"details": [
{
"description": "Beneficiary may request a fee-free Visa debit card. Any fees the beneficiary incurs using the TCA debit card are credited right back to the account."
}
]
},
{
"serviceName": "Link to Payment Apps/Services",
"details": [
{
"description": "Beneficiary has the ability to link the account to popular payment apps/services such as PayPal®, Venmo® or Square Cash SM"
}
]
},
{
"serviceName": "Funds Transfer",
"details": [
{
"description": "Beneficiary may transfer funds from the TCA at any time without fees through ACH and bank to bank wires."
}
]
},
{
"serviceName": "Interest Rate",
"details": [
{
"description": "The account begins to earn interest from day one. The interest rate on the account will never be lower than the Guaranteed Minimum Rate of .50%."
}
]
},
{
"serviceName": "No Fees",
"details": [
{
"description": "No monthly maintenance fees, no ATM fees, or charges for writing drafts, reordering drafts or making withdrawals. Charges may apply for an overdrawn TCA or special services."
}
]
},
{
"serviceName": "Quarterly Statements",
"details": [
{
"description": "Every quarter, a personalized statement of the account detailing any activity since the previous quarter is sent to the beneficiary."
}
]
},
{
"serviceName": "Customer Service",
"details": [
{
"description": "Dedicated US-based Customer Service Representatives are available through a special toll-free number (800-638-7283)."
}
]
},
{
"serviceName": "Automated Phone System",
"details": [
{
"description": "Through MetLife's automated phone system, Accountholders are able to touch or speak their requests into the phone such as, \"hear account balance\", \"get recent transactions\", and \"order drafts.\""
}
]
},
{
"serviceName": "Online Bill Payments",
"details": [
{
"description": "Beneficiary may conveniently use the TCA as a source of funds to pay bills online or by phone (no minimum payment amount), and link to his or her favorite mobile payment service."
}
]
}
]
},
{
"category": "Accelerated Benefits Option",
"services": [
{
"serviceName": "Minimum Acceleration Amount",
"details": [
{
"description": "The minimum that can be accelerated is $20,000."
}
]
}
]
},
{
"category": "Waiver of Premium",
"services": [
{
"serviceName": "Total Disability",
"details": [
{
"description": "Group life coverage is continued for an employee meeting the contractual definition of total disability. No further premium payment for that employee is required."
}
]
}
]
},
{
"category": "Enrollment",
"services": [
{
"serviceName": "Statement of Health",
"details": [
{
"description": "A statement of health will need to be submitted by employees who request coverage amounts during their initial 31-day enrollment that exceed the stated MEOI level, apply for coverage after the period which begins on the first day on which they are eligible for the coverage, have been hospitalized in the last 90 days, or have indicated a medical condition on their enrollment form."
}
]
}
]
},
{
"category": "Benefit Increases",
"services": [
{
"serviceName": "Supplemental Term Life",
"details": [
{
"description": "Employees, Actively at Work, who are participating in the plan may increase their coverage up to the next benefit level without submitting a statement of health, provided the increased benefit does not exceed the Medical Evidence Level."
}
]
},
{
"serviceName": "Dependent Supplemental Term Life",
"details": [
{
"description": "Employees, Actively at Work, who are participating in the plan and want to increase their coverage by any amount will have to submit a statement of health."
}
]
}
]
},
{
"category": "Limitations and Exclusions",
"services": [
{
"serviceName": "Limitations",
"details": [
{
"description": "The Accidental Death & Dismemberment loss must occur within 365 days after the date of the accident and be a direct result of bodily injury sustained from that accident, independent of other causes."
}
]
},
{
"serviceName": "Exclusions",
"details": [
{
"description": "Accidental Death & Dismemberment insurance does not include payment for any loss which in any way results from or is caused by or contributed to by physical or mental illness or infirmity, infection, suicide or attempted suicide, intentionally self-inflicted injury, service in the armed forces of any country or international authority, any incident related to travel in an aircraft as a pilot, crew member, flight student or while acting in any capacity other than as a passenger, committing or attempting to commit a felony, the voluntary intake or use by any means of any drug, medication or sedative, alcohol in combination with any drug, medication, or sedative, poison, gas, or fumes, war, whether declared or undeclared; or act of war, insurrection, rebellion, riot, driving a vehicle or operating another device while intoxicated."
}
]
}
]
}
]
},
{
"planName": "Supplemental Term Life",
"rates": {
"rateTables": [
{
"rateGuarantee": "Broker Commissions: Flat 10.00%",
"rows": [
{
"description": "Expected Participation",
"lives": 10,
"estimatedMonthlyCost": 33
},
{
"description": "Employee Contributions",
"estimatedMonthlyCost": 100
},
{
"description": "Benefits terminate at retirement"
}
]
}
]
},
"coveredServices": []
},
{
"planName": "Supplemental Term AD&D",
"rates": {
"rateTables": [
{
"rateGuarantee": "Broker Commissions: Flat 15.00%",
"rows": [
{
"description": "Expected Participation",
"lives": null,
"estimatedMonthlyCost": 25
},
{
"description": "Employee Contributions",
"estimatedMonthlyCost": 100
},
{
"description": "Benefits terminate at retirement"
}
]
}
]
},
"coveredServices": []
},
{
"planName": "Supplemental Dependent Life",
"rates": {
"rateTables": [
{
"rateGuarantee": "Broker Commissions: Flat 10.00%",
"rows": [
{
"description": "Expected Participation",
"lives": null,
"estimatedMonthlyCost": 25
},
{
"description": "Employee Contributions",
"estimatedMonthlyCost": 100
},
{
"description": "Benefits terminate at retirement"
}
]
}
]
},
"coveredServices": []
},
{
"planName": "Supplemental Dependent AD&D",
"rates": {
"rateTables": [
{
"rateGuarantee": "Broker Commissions: Flat 10.00%",
"rows": [
{
"description": "Expected Participation",
"lives": null,
"estimatedMonthlyCost": 25
},
{
"description": "Employee Contributions",
"estimatedMonthlyCost": 100
},
{
"description": "Benefits terminate at retirement"
}
]
}
]
},
"coveredServices": []
},
{
"planName": "Voluntary Dental - PPO - PDP Plus Network",
"rates": {
"rateTables": [
{
"rateGuarantee": "January 1, 2023 - December 31, 2023 (12 months)",
"rows": [
{
"description": "Employee Only",
"lives": 20,
"monthlyRate": 44.72,
"estimatedMonthlyCost": 2077,
"estimatedAnnualCost": 24921
},
{
"description": "Employee + Spouse",
"lives": 3,
"monthlyRate": 89.19
},
{
"description": "Employee + Child(ren)",
"lives": 3,
"monthlyRate": 99.47
},
{
"description": "Employee + Family",
"lives": 4,
"monthlyRate": 154.09
},
{
"description": "Employee Only",
"lives": 30,
"monthlyRate": 38.58,
"estimatedMonthlyCost": 2486,
"estimatedAnnualCost": 29838
},
{
"description": "Employee + Spouse",
"lives": 5,
"monthlyRate": 76.95
},
{
"description": "Employee + Child(ren)",
"lives": 4,
"monthlyRate": 79.41
},
{
"description": "Employee + Family",
"lives": 5,
"monthlyRate": 125.34
}
]
}
]
},
"coveredServices": [
{
"category": "Dental Insurance",
"services": [
{
"serviceName": "Type A - Preventive",
"details": [
{
"description": "In-Network/Out-of-Network",
"benefit": "100%"
},
{
"description": "Calendar Year Maximum",
"allowance": "$2,500/$1,500"
}
]
},
{
"serviceName": "Type B - Basic",
"details": [
{
"description": "In-Network",
"benefit": "90%/80%"
},
{
"description": "Out-of-Network",
"benefit": "90%/80%"
},
{
"description": "Calendar Year Deductible",
"allowance": "B & C $50 $150 Aggregate"
}
]
},
{
"serviceName": "Type C - Major",
"details": [
{
"description": "In-Network",
"benefit": "60%/50%"
},
{
"description": "Out-of-Network",
"benefit": "60%/50%"
}
]
},
{
"serviceName": "Orthodontia",
"details": [
{
"description": "In-Network",
"benefit": "50%",
"coveredFor": "All Active Full Time Employees Electing High plan"
},
{
"description": "Orthodontia Lifetime Maximum",
"allowance": "$2,000",
"coveredFor": "All Active Full Time Employees Electing High plan"
}
]
}
]
}
]
},
{
"planName": "Custom Primary (Flex) - Custom Lower Cost (Flex)",
"rates": {},
"coveredServices": [
{
"category": "Class Description: All Active Full Time Employees Electing High plan",
"services": [
{
"serviceName": "Examinations",
"details": [
{
"description": "1 time in 6 months"
}
]
},
{
"serviceName": "Examinations - Problem Focused",
"details": [
{
"description": "Combined with Examinations Limit"
}
]
},
{
"serviceName": "Prophylaxis: Cleanings",
"details": [
{
"description": "1 time in 6 months"
}
]
},
{
"serviceName": "Fluoride",
"details": [
{
"description": "1 time in 12 months for a dependent child under age 14"
}
]
},
{
"serviceName": "Bitewing X-Rays",
"details": [
{
"description": "For a child under 14: 1 time in 12 months",
"coveredFor": "Child under 14"
},
{
"description": "Adult: 1 time in 12 months",
"coveredFor": "Adult"
}
]
},
{
"serviceName": "Sealants",
"details": [
{
"description": "1 per molar in 60 months for a child under age 14"
}
]
},
{
"serviceName": "Full Mouth X-Rays",
"details": [
{
"description": "Once in 60 months"
}
]
},
{
"serviceName": "Amalgam Fillings",
"details": [
{
"description": "1 replacement per surface in 24 Months"
}
]
},
{
"serviceName": "Root Canal",
"details": [
{
"description": "1 per tooth per lifetime"
}
]
},
{
"serviceName": "Periodontal Maintenance",
"details": [
{
"description": "4 perio. Treatments in 1 calendar yr, includes 2 cleanings (total comb: 4)"
}
]
},
{
"serviceName": "Periodontal Surgery",
"details": [
{
"description": "1 per quadrant in any 60 month period"
}
]
},
{
"serviceName": "Scaling & Root Planing",
"details": [
{
"description": "1 per quadrant in any 36 month period"
}
]
},
{
"serviceName": "Space Maintainers",
"details": [
{
"description": "1 per lifetime for a child under age 14"
}
]
},
{
"serviceName": "Consultations",
"details": [
{
"description": "1 in 12 months"
}
]
},
{
"serviceName": "Prefabricated Crowns",
"details": [
{
"description": "1 per tooth in 10 calendar years"
}
]
},
{
"serviceName": "Crown Buildups / Post Core",
"details": [
{
"description": "1 per tooth in 10 calendar years"
}
]
},
{
"serviceName": "Repairs",
"details": [
{
"description": "1 in 12 months"
}
]
},
{
"serviceName": "Recementations",
"details": [
{
"description": "1 in 12 months"
}
]
},
{
"serviceName": "Dentures",
"details": [
{
"description": "1 in 10 calendar years"
}
]
},
{
"serviceName": "Immediate Temporary Dentures - Complete / Partial",
"details": [
{
"description": "1 replacement in 12 months"
}
]
},
{
"serviceName": "Dentures - Rebases / Relines",
"details": [
{
"description": "1 in 36 months"
}
]
},
{
"serviceName": "Denture Adjustments",
"details": [
{
"description": "1 in 12 months"
}
]
},
{
"serviceName": "Fixed Bridges",
"details": [
{
"description": "1 in 10 calendar years"
}
]
},
{
"serviceName": "Inlays / Onlays /Crowns",
"details": [
{
"description": "1 replacement per tooth in 10 calendar years"
}
]
},
{
"serviceName": "Implant Services",
"details": [
{
"description": "1 per tooth position in 10 calendar years"
}
]
},
{
"serviceName": "Implant Repairs",
"details": [
{
"description": "1 per tooth in 10 calendar years"
}
]
},
{
"serviceName": "Implant Supported Prosthetic",
"details": [
{
"description": "1 per tooth in 10 calendar years"
}
]
},
{
"serviceName": "Tissue Conditioning",
"details": [
{
"description": "1 in 36 months"
}
]
},
{
"serviceName": "Occlusal Adjustments",
"details": [
{
"description": "1 in 12 months"
}
]
}
]
}
]
},
{
"planName": "High",
"rates": {},
"coveredServices": [
{
"category": "Exclusions",
"services": [
{
"serviceName": "General Exclusions",
"details": [
{
"description": "Services which are not dentally necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which we deem experimental in nature."
},
{
"description": "Services for which a covered person would not be required to pay in the absence of dental insurance."
},
{
"description": "Services or supplies received by a covered person before the insurance starts for that person."
},
{
"description": "Services which are neither performed nor prescribed by a dentist except for those services of a licensed dental hygienist which are supervised and billed by a dentist and which are for scaling or polishing of teeth or fluoride treatment."
},
{
"description": "Services which are primarily cosmetic.",
"coveredFor": "For residents of Texas: Services which are primarily cosmetic unless required for the treatment or correction of a congenital defect of a newborn child."
},
{
"description": "Services or appliances which restore or alter occlusion or vertical dimension."
},
{
"description": "Restoration of tooth structure damaged by attrition, abrasion or erosion unless caused by disease."
},
{
"description": "Restorations or appliances used for the purpose of periodontal splinting."
},
{
"description": "Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco."
},
{
"description": "Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss."
},
{
"description": "Initial installation of a Denture to replace one or more teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth."
},
{
"description": "Decoration or inscription of any tooth, device, appliance, crown or other dental work."
},
{
"description": "Missed appointments."
},
{
"description": "Services covered under any workers' compensation or occupational disease law."
},
{
"description": "Services covered under any employer liability law."
},
{
"description": "Services for which the employer of the person receiving such services is not required to pay."
},
{
"description": "Services received at a facility maintained by the Policyholder, labor union, mutual benefit association, or VA hospital."
},
{
"description": "Services covered under other coverage provided by the Policyholder."
},
{
"description": "Temporary or provisional restorations."
},
{
"description": "Temporary or provisional appliances."
},
{
"description": "Prescription drugs."
},
{
"description": "Services for which the submitted documentation indicates a poor prognosis."
},
{
"description": "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 Dental Insurance under the group policy be paid first."
},
{
"description": "The following when charged by the dentist on a separate basis - Claim form completion; infection control such as gloves, masks, and sterilization of supplies; or local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide."
},
{
"description": "Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing and biting of food."
},
{
"description": "Caries susceptibility tests."
},
{
"description": "Precision attachments associated with fixed and removable prostheses."
},
{
"description": "Adjustment of a denture made within 6 months after installation by the same dentist who installed it."
},
{
"description": "Duplicate prosthetic devices or appliances."
},
{
"description": "Replacement of a lost or stolen appliance, cast restoration or denture."
},
{
"description": "Intra and extraoral photographic images."
},
{
"description": "Fixed and removable appliances for correction of harmful habits."
},
{
"description": "Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards."
},
{
"description": "Treatment of temporomandibular joint disorder.",
"coveredFor": "This exclusion does not apply to residents of Minnesota."
},
{
"description": "Implants supported prosthetics to replace one or more teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth."
}
]
}
]
}
]
},
{
"planName": "Custom Primary (Flex) - Custom Lower Cost (Flex)",
"coveredServices": [
{
"category": "Class Description: All Active Full Time Employees Electing Low plan",
"services": [
{
"serviceName": "Examinations",
"details": [
{
"description": "1 time in 6 months"
}
]
},
{
"serviceName": "Examinations - Problem Focused",
"details": [
{
"description": "Combined with Examinations Limit"
}
]
},
{
"serviceName": "Prophylaxis: Cleanings",
"details": [
{
"description": "1 time in 6 months"
}
]
},
{
"serviceName": "Fluoride",
"details": [
{
"description": "1 time in 12 months for a dependent child under age 14"
}
]
},
{
"serviceName": "Bitewing X-Rays",
"details": [
{
"description": "For a child under 14: 1 time in 12 months",
"coveredFor": "Child under 14"
},
{
"description": "1 time in 12 months",
"coveredFor": "Adult"
}
]
},
{
"serviceName": "Sealants",
"details": [
{
"description": "1 per molar in 60 months",
"coveredFor": "Child under age 14"
}
]
},
{
"serviceName": "Full Mouth X-Rays",
"details": [
{
"description": "Once in 60 months"
}
]
},
{
"serviceName": "Amalgam Fillings",
"details": [
{
"description": "1 replacement per surface in 24 Months"
}
]
},
{
"serviceName": "Root Canal",
"details": [
{
"description": "1 per tooth per lifetime"
}
]
},
{
"serviceName": "Periodontal Maintenance",
"details": [
{
"description": "4 perio. Treatments in 1 calendar yr, includes 2 cleanings (total comb: 4)"
}
]
},
{
"serviceName": "Periodontal Surgery",
"details": [
{
"description": "1 per quadrant in any 60 month period"
}
]
},
{
"serviceName": "Scaling & Root Planing",
"details": [
{
"description": "1 per quadrant in any 36 month period"
}
]
}
]
},
{
"category": "TYPE C",
"services": [
{
"serviceName": "Space Maintainers",
"details": [
{
"description": "1 per lifetime",
"coveredFor": "Child under age 14"
}
]
},
{
"serviceName": "Consultations",
"details": [
{
"description": "1 in 12 months"
}
]
},
{
"serviceName": "Prefabricated Crowns",
"details": [
{
"description": "1 per tooth in 10 calendar years"
}
]
},
{
"serviceName": "Crown Buildups / Post Core",
"details": [
{
"description": "1 per tooth in 10 calendar years"
}
]
},
{
"serviceName": "Repairs",
"details": [
{
"description": "1 in 12 months"
}
]
},
{
"serviceName": "Recementations",
"details": [
{
"description": "1 in 12 months"
}
]
},
{
"serviceName": "Dentures",
"details": [
{
"description": "1 in 10 calendar years"
}
]
},
{
"serviceName": "Immediate Temporary Dentures - Complete / Partial",
"details": [
{
"description": "1 replacement in 12 months"
}
]
},
{
"serviceName": "Dentures - Rebases / Relines",
"details": [
{
"description": "1 in 36 months"
}
]
},
{
"serviceName": "Denture Adjustments",
"details": [
{
"description": "1 in 12 months"
}
]
},
{
"serviceName": "Fixed Bridges",
"details": [
{
"description": "1 in 10 calendar years"
}
]
},
{
"serviceName": "Inlays / Onlays /Crowns",
"details": [
{
"description": "1 replacement per tooth in 10 calendar years"
}
]
},
{
"serviceName": "Implant Services",
"details": [
{
"description": "1 per tooth position in 10 calendar years"
}
]
},
{
"serviceName": "Implant Repairs",
"details": [
{
"description": "1 per tooth in 10 calendar years"
}
]
},
{
"serviceName": "Implant Supported Prosthetic",
"details": [
{
"description": "1 per tooth in 10 calendar years"
}
]
},
{
"serviceName": "Tissue Conditioning",
"details": [
{
"description": "1 in 36 months"
}
]
},
{
"serviceName": "Occlusal Adjustments",
"details": [
{
"description": "1 in 12 months"
}
]
}
]
}
]
},
{
"planName": "Low",
"coveredServices": [
{
"category": "Exclusions",
"services": [
{
"serviceName": "General Exclusions",
"details": [
{
"description": "Services which are not dentally necessary, those which do not meet generally accepted standards of care for treating the particular dental condition, or which we deem experimental in nature."
},
{
"description": "Services for which a covered person would not be required to pay in the absence of dental insurance."
},
{
"description": "Services or supplies received by a covered person before the insurance starts for that person."
},
{
"description": "Services which are neither performed nor prescribed by a dentist except for those services of a licensed dental hygienist which are supervised and billed by a dentist and which are for scaling or polishing of teeth or fluoride treatment."
},
{
"description": "Services which are primarily cosmetic. (For residents of Texas: Services which are primarily cosmetic unless required for the treatment or correction of a congenital defect of a newborn child)."
},
{
"description": "Services or appliances which restore or alter occlusion or vertical dimension."
},
{
"description": "Restoration of tooth structure damaged by attrition, abrasion or erosion unless caused by disease."
},
{
"description": "Restorations or appliances used for the purpose of periodontal splinting."
},
{
"description": "Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco."
},
{
"description": "Personal supplies or devices including, but not limited to: water piks, toothbrushes, or dental floss."
},
{
"description": "Initial installation of a Denture to replace one or more teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth."
},
{
"description": "Decoration or inscription of any tooth, device, appliance, crown or other dental work."
},
{
"description": "Missed appointments."
},
{
"description": "Services covered under any workers' compensation or occupational disease law."
},
{
"description": "Services covered under any employer liability law."
},
{
"description": "Services for which the employer of the person receiving such services is not required to pay."
},
{
"description": "Services received at a facility maintained by the Policyholder, labor union, mutual benefit association, or VA hospital."
},
{
"description": "Services covered under other coverage provided by the Policyholder."
},
{
"description": "Temporary or provisional restorations."
},
{
"description": "Temporary or provisional appliances."
},
{
"description": "Prescription drugs."
},
{
"description": "Services for which the submitted documentation indicates a poor prognosis."
},
{
"description": "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 Dental Insurance under the group policy be paid first."
},
{
"description": "The following when charged by the dentist on a separate basis - Claim form completion; infection control such as gloves, masks, and sterilization of supplies; or local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide."
},
{
"description": "Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing and biting of food."
},
{
"description": "Caries susceptibility tests."
},
{
"description": "Precision attachments associated with fixed and removable prostheses."
},
{
"description": "Adjustment of a denture made within 6 months after installation by the same dentist who installed it."
},
{
"description": "Duplicate prosthetic devices or appliances."
},
{
"description": "Replacement of a lost or stolen appliance, cast restoration or denture."
},
{
"description": "Intra and extraoral photographic images."
},
{
"description": "Fixed and removable appliances for correction of harmful habits."
},
{
"description": "Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards."
},
{
"description": "Treatment of temporomandibular joint disorder. This exclusion does not apply to residents of Minnesota."
},
{
"description": "Orthodontia services or appliances."
},
{
"description": "Repair or a replacement of an orthodontic appliance."
},
{
"description": "Implants supported prosthetics to replace one or more teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth."
}
]
}
]
}
]
},
{
"planName": "Not specified",
"rates": {
"rateTables": []
},
"coveredServices": [
{
"category": "General Information",
"services": [
{
"serviceName": "Broker Commissions",
"details": [
{
"description": "Included in the rate",
"benefit": "Flat 10.00%"
}
]
},
{
"serviceName": "Expected Participation",
"details": [
{
"description": "Minimum requirements",
"benefit": "83% and at least 10 covered lives"
}
]
},
{
"serviceName": "Employee Contributions",
"details": [
{
"description": "Contribution level",
"benefit": "100%"
}
]
},
{
"serviceName": "Financial Arrangement",
"details": [
{
"description": "Type of arrangement",
"benefit": "Non-retrospectively Experience Rated"
}
]
},
{
"serviceName": "Situs",
"details": [
{
"description": "Location of policy",
"benefit": "CALIFORNIA"
}
]
},
{
"serviceName": "Eligibility",
"details": [
{
"description": "Residency requirement",
"benefit": "Only those residing in the United States"
}
]
},
{
"serviceName": "Dependent Child Definition",
"details": [
{
"description": "Age limit for coverage",
"benefit": "A Child is covered up to age 26, A student is covered up to age 26."
}
]
},
{
"serviceName": "Ortho Coverage",
"details": [
{
"description": "Applies to Voluntary Dental",
"benefit": "All Active Full Time Employees Electing High plan: Adult/Child Ortho. Children are covered to age 19. All Active Full Time Employees Electing Low plan: No Coverage."
}
]
},
{
"serviceName": "Plan Type",
"details": [
{
"description": "Assumption about the plan",
"benefit": "This quote assumes the plan is a Section 125 plan."
}
]
},
{
"serviceName": "Open Enrollment",
"details": [
{
"description": "Enrollment period",
"benefit": "An Open Enrollment period occurring annually"
}
]
}
]
}
]
},
{
"planName": "TakeAlong Dental",
"rates": {
"rateTables": []
},
"coveredServices": [
{
"category": "Eligibility",
"services": [
{
"serviceName": "Individual Enrollment",
"details": [
{
"description": "Individuals and their dependents who are ineligible for your group dental plan can enroll directly through the MetLife TakeAlong Dental website or dedicated call center.",
"coveredFor": "Individuals and their dependents"
}
]
},
{
"serviceName": "Cost to Company",
"details": [
{
"description": "There's no cost to the company for employees to enroll in the TakeAlong Dental plan."
}
]
}
]
},
{
"category": "Service Experience",
"services": [
{
"serviceName": "Network and Service Quality",
"details": [
{
"description": "Offers the same high-quality network and service experience that your employees deserve."
}
]
}
]
}
]
},
{
"coveredServices": [
{
"category": "Frequency / Exclusions",
"services": [
{
"serviceName": "Examinations",
"details": [
{
"description": "Frequency",
"frequency": "1 per 12 Months"
}
]
},
{
"serviceName": "Standard Corrective Lenses",
"details": [
{
"description": "Frequency",
"frequency": "1 per 12 Months"
}
]
},
{
"serviceName": "Frames",
"details": [
{
"description": "Frequency",
"frequency": "1 per 12 Months"
}
]
},
{
"serviceName": "Contact Lenses",
"details": [
{
"description": "Frequency",
"frequency": "1 per 12 Months"
}
]
},
{
"serviceName": "Glasses or Contacts",
"details": [
{
"description": "Either glasses or contacts allowed per frequency"
}
]
}
]
}
]
},
{
"planName": "Vision Insurance",
"coveredServices": [
{
"category": "Exclusions",
"services": [
{
"serviceName": "General Exclusions",
"details": [
{
"description": "Services and/or materials not specifically included in the Summary of Benefits as covered Plan Benefits."
},
{
"description": "Any portion of a charge in excess of the Maximum Benefit Allowance or reimbursement indicated in the Summary of Benefits."
},
{
"description": "Plano lenses (lenses with refractive correction of less than + .50 diopter)"
},
{
"description": "Two pairs of glasses instead of bifocals."
},
{
"description": "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."
},
{
"description": "Orthoptics or vision training and any associated supplemental testing."
},
{
"description": "Medical or surgical treatment of the eyes."
},
{
"description": "Prescription and non-prescription medications."
},
{
"description": "Contact lens insurance policies or service agreements."
},
{
"description": "Refitting of contact lenses after the initial (90-day) fitting period."
},
{
"description": "Contact lens modification, polishing or cleaning."
},
{
"description": "Local, state and/or federal taxes, except where MetLife is required by law to pay."
},
{
"description": "Any eye examination or any corrective eyewear required as a condition of employment."
},
{
"description": "Services and supplies received by You or Your Dependent before the Vision Insurance starts for that person."
},
{
"description": "Missed appointments."
},
{
"description": "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."
},
{
"description": "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."
},
{
"description": "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."
},
{
"description": "Services and materials obtained while outside the United States, except for emergency vision care."
},
{
"description": "Services, procedures, or materials for which a charge would not have been made in the absence of insurance."
}
]
}
]
}
]
},
{
"planName": "MetLife Cost & Benefits Summary",
"rates": {
"rateTables": [
{
"rateGuarantee": "Broker Commissions included in the rate: Flat 10.00%",
"rows": [
{
"description": "Expected Participation",
"monthlyRate": 76
},
{
"description": "Employee Contributions",
"monthlyRate": 100
},
{
"description": "Non-retrospectively Experience Rated"
},
{
"description": "CALIFORNIA"
},
{
"description": "7372"
},
{
"description": "A Child is covered up to age 26; A student is covered up to age 26."
},
{
"description": "This quote assumes the plan is a Section 125 plan."
},
{
"description": "An Open Enrollment period occurring annually is included"
}
]
}
]
},
"coveredServices": []
},
{
"planName": "Short Term Disability - Employer Paid",
"rates": {
"rateTables": [
{
"rateGuarantee": "January 1, 2023 - December 31, 2024 (24 months)",
"rows": [
{
"description": "STD",
"monthlyRate": 786,
"estimatedMonthlyCost": 786,
"estimatedAnnualCost": 9437
}
]
}
]
},
"coveredServices": [
{
"category": "Disability Benefits",
"services": [
{
"serviceName": "Short Term Disability",
"details": [
{
"description": "Class Description",
"benefit": "All Active Full Time Employees (30 Hours)"
},
{
"description": "Weekly Benefit Amount",
"benefit": "60%"
},
{
"description": "Maximum Weekly Benefit",
"benefit": "$2,500"
},
{
"description": "Minimum Weekly Benefit",
"benefit": "$20",
"details": "* The minimum weekly benefit is subject to overpayment situations and any applicable rehabilitation incentives."
},
{
"description": "Elimination Period",
"benefit": "Accident - 7 days, Sickness - 7 days"
},
{
"description": "Benefit Duration",
"benefit": "12 weeks"
},
{
"description": "Rehabilitation Incentives",
"benefit": "Work Incentive Rehabilitation Program Incentive, Family Care Incentive, Moving Expense Incentive"
}
]
}
]
}
]
},
{
"planName": "All Active Full Time Employees",
"rates": {},
"coveredServices": [
{
"category": "Limitations and Definitions",
"services": [
{
"serviceName": "Definition of Disability",
"details": [
{
"description": "Disability or Disabled means that as a result of Sickness or injury the employee is either Totally or Partially Disabled. Totally Disabled or Total Disability means the employee is unable to perform with reasonable continuity the Substantial and Material Acts necessary to pursue the employee's Usual Occupation and the employee is not working in the employee's Usual Occupation. Partially Disabled or Partial Disability means while actually working in the employee's Usual Occupation, the employee is unable to earn 80% or more of the employee's Predisability Earnings.",
"coveredFor": "the employee"
}
]
},
{
"serviceName": "Pre-Existing Condition",
"details": [
{
"description": "None"
}
]
},
{
"serviceName": "Pre-Existing Condition Limitation",
"details": [
{
"description": "None"
}
]
},
{
"serviceName": "Reduction of Benefits",
"details": [
{
"description": "Benefits will be reduced by income and recoveries paid from certain other sources including but not limited to: any disability benefits under Federal Social Security Act, or any similar plan or act; temporary disability benefits under a workers' compensation law; amounts under any other occupational disease law; any disability benefits under any state compulsory/statutory benefit law; any government retirement system, including but not limited to the California State Teachers Retirement System (CalSTRS) and/or the California Public Employee Retirement System (CalPERS) and/or the Federal Employee Retirement System (FERS); the Policyholder's retirement plan; any retirement benefits under: Federal Social Security Act, or any similar plan or act; third party liability payments by judgment, settlement or otherwise (minus attorneys' fees); sick pay; any salary continuation, personal time off, and annual leave pay.",
"coveredFor": "the employee"
}
]
},
{
"serviceName": "Occupational Benefits",
"details": [
{
"description": "Non-Occupational Coverage"
}
]
},
{
"serviceName": "Definition of Predisability Earnings",
"details": [
{
"description": "The amount of the employee's gross salary or wages from his/her employer as of the day before his/her disability began. Predisability earnings includes: Basic earnings only. The term does not include: The grant, award, sale, conversion, and/or exercise of shares of stock or stock options; The Employer's contributions on Your behalf to any deferred compensation arrangement or pension plan; or Any other compensation from the Employer.",
"coveredFor": "the employee"
}
]
},
{
"serviceName": "Work Incentive",
"details": [
{
"description": "While disabled and receiving a Weekly Benefit, employees may receive up to 100% of Predisability Weekly Earnings, return-to-work earnings, and other income benefits.",
"coveredFor": "the employee"
}
]
},
{
"serviceName": "Rehabilitation Incentive",
"details": [
{
"description": "10% increase in the Weekly Benefit if participating in an approved Rehabilitation Program.",
"coveredFor": "the employee"
}
]
},
{
"serviceName": "Family Care Incentive",
"details": [
{
"description": "If the employee works or participates in a Rehabilitation Program while they are Disabled, starting with the 4th Weekly Benefit payment, reimbursement may be provided for up to $100 per week for eligible Family Care expenses incurred by an employee for each eligible family member during the benefit period.",
"coveredFor": "the employee"
}
]
},
{
"serviceName": "Moving Expense Incentive",
"details": [
{
"description": "If the employee participates in a Rehabilitation Program while they are Disabled, reimbursement may be provided for expenses incurred in order to move to a new residence if recommended as part of the Rehabilitation Program.",
"coveredFor": "the employee"
}
]
},
{
"serviceName": "Temporary Recovery",
"details": [
{
"description": "If the employee returns to Active Work before completing the Elimination Period and then becomes Disabled, they will have to complete a new elimination period. If the employee returns to Active Work, after they begin to receive Weekly Benefits, for a period of 20 days or less than becomes Disabled again due to the same or related condition, they will not have to complete a new Elimination Period.",
"coveredFor": "the employee"
}
]
},
{
"serviceName": "Continuity of Coverage",
"details": [
{
"description": "Provided for groups where this plan will replace an inforce insured plan in force on the day immediately preceding the effective date of this plan.",
"coveredFor": "the employee"
}
]
},
{
"serviceName": "Organ Donor Benefit",
"details": [
{
"description": "10% increase in the Weekly Benefit if Disability is a result of an Organ Transplant Procedure.",
"coveredFor": "the employee"
}
]
}
]
}
]
},
{
"planName": "Short Term Benefits",
"coveredServices": [
{
"category": "Exclusions",
"services": [
{
"serviceName": "General Exclusions",
"details": [
{
"description": "War, whether declared or undeclared, or act of war, insurrection, rebellion, or terrorist act",
"coveredFor": "Not Covered"
},
{
"description": "Your active participation in a riot",
"coveredFor": "Not Covered"
},
{
"description": "Intentionally self-inflicted injury",
"coveredFor": "Not Covered"
},
{
"description": "Any injury for which You are entitled to benefits under Workers' Compensation or a similar law",
"coveredFor": "Not Covered"
},
{
"description": "Attempted suicide",
"coveredFor": "Not Covered"
},
{
"description": "Commission of or attempt to commit a felony",
"coveredFor": "Not Covered"
}
]
},
{
"serviceName": "Exclusions Specific to Short Term Benefits",
"details": [
{
"description": "Cosmetic surgery or treatment primarily to change appearance",
"coveredFor": "Not Covered"
},
{
"description": "Reversal of sterilization",
"coveredFor": "Not Covered"
},
{
"description": "Liposuction",
"coveredFor": "Not Covered"
},
{
"description": "Visual correction surgery",
"coveredFor": "Not Covered"
},
{
"description": "In vitro fertilization, embryo transfer procedure, or artificial insemination",
"coveredFor": "Not Covered"
}
]
}
]
}
]
},
{
"planName": "Short Term Disability Coverage",
"rates": {},
"coveredServices": [
{
"category": "General Provisions",
"services": [
{
"serviceName": "Broker Commissions",
"details": [
{
"description": "Included in the rate",
"benefit": "Flat 10.00%"
}
]
},
{
"serviceName": "Expected Participation",
"details": [
{
"description": "Expected level of participation",
"benefit": "100%"
}
]
},
{
"serviceName": "Employee Contributions",
"details": [
{
"description": "Employee contribution rate",
"benefit": "0%"
}
]
},
{
"serviceName": "Financial Arrangement",
"details": [
{
"description": "Type of financial arrangement",
"benefit": "Non-retrospectively Experience Rated"
}
]
},
{
"serviceName": "Situs",
"details": [
{
"description": "Location of legal use",
"benefit": "CALIFORNIA"
}
]
},
{
"serviceName": "Benefit Offsets",
"details": [
{
"description": "For employees with Mandated State Disability Laws",
"benefit": "Supplemental to state mandated benefits"
}
]
},
{
"serviceName": "Actively at Work Provision",
"details": [
{
"description": "Provision applies",
"benefit": "Yes"
}
]
},
{
"serviceName": "Employer FICA Match",
"details": [
{
"description": "MetLife's role in FICA remittance",
"benefit": "Employer responsible for FICA remittance and reporting"
}
]
},
{
"serviceName": "Rehabilitation Program Participation",
"details": [
{
"description": "Requirement for continued disability benefit payments",
"benefit": "Participation required"
}
]
}
]
}
]
},
{
"planName": "Long Term Disability - Employer Paid",
"rates": {
"rateTables": [
{
"rateGuarantee": "January 1, 2023 - December 31, 2024 (24 months)",
"rows": [
{
"description": "Standalone",
"monthlyRate": 0.085,
"lives": null,
"estimatedMonthlyCost": 668,
"estimatedAnnualCost": 8011
}
]
}
]
},
"coveredServices": [
{
"category": "Disability Benefits",
"services": [
{
"serviceName": "Monthly Benefit",
"details": [
{
"description": "66.670% of Predisability Earnings"
}
]
},
{
"serviceName": "Maximum Monthly Benefit",
"details": [
{
"description": "$10,000.00"
}
]
},
{
"serviceName": "Minimum Monthly Benefit",
"details": [
{
"description": "$100.00"
}
]
},
{
"serviceName": "Elimination Period",
"details": [
{
"description": "90 Days or until the end of the STD Maximum Benefit Period."
}
]
},
{
"serviceName": "Own Occupation Period",
"details": [
{
"description": "24 months"
}
]
},
{
"serviceName": "Social Security Integration",
"details": [
{
"description": "Family Social Security"
}
]
},
{
"serviceName": "Benefit Duration",
"details": [
{
"description": "RBD w/ SSNRA",
"benefit": "The later of Your Normal Retirement Age as defined by Social Security or the period shown below:",
"coveredFor": "less than 60 to age 65, 60 for 60 months, 61 for 48 months, 62 for 42 months, 63 for 36 months, 64 for 30 months, 65 for 24 months, 66 for 21 months, 67 for 18 months, 68 for 15 months, 69 and over for 12 months"
}
]
},
{
"serviceName": "Rehabilitation Incentives",
"details": [
{
"description": "Work Incentive"
},
{
"description": "Rehabilitation Program Incentive"
},
{
"description": "Family Care Incentive"
},
{
"description": "Moving Expense Incentive"
}
]
},
{
"serviceName": "Employee Assistance Program",
"details": [
{
"description": "Employee Assistance Program is not included."
}
]
},
{
"serviceName": "Survivor Benefit",
"details": [
{
"description": "Included in this quote"
}
]
},
{
"serviceName": "Cost of Living Adjustment",
"details": [
{
"description": "Cost of Living Adjustment does not apply."
}
]
}
]
}
]
},
{
"planName": "Disability Insurance",
"rates": {},
"coveredServices": [
{
"category": "Definitions",
"services": [
{
"serviceName": "Disability or Disabled",
"details": [
{
"description": "Means that as a result of Sickness or injury the employee is either Totally Disabled or Partially Disabled."
}
]
},
{
"serviceName": "Totally Disabled or Total Disability",
"details": [
{
"description": "During the Elimination Period and the next 24 months, unable to perform the Substantial and Material Acts necessary to pursue Usual Occupation in the usual way."
},
{
"description": "After such period, not able to engage in any occupation reasonably expected to perform satisfactorily in light of age, education, training, experience, station in life, and physical and mental capacity."
}
]
},
{
"serviceName": "Partially Disabled or Partial Disability",
"details": [
{
"description": "While working, unable to earn 80% or more of Predisability Earnings."
}
]
}
]
},
{
"category": "Adjustments and Incentives",
"services": [
{
"serviceName": "Predisability Earnings Adjustment",
"details": [
{
"description": "MetLife will adjust the employee's Predisability Earnings for the purpose of determining Partial Disability and calculating Return to Work Incentive, based on the annual rate of increase in the Consumer Price Index."
}
]
},
{
"serviceName": "Work Incentive",
"details": [
{
"description": "May receive up to 100% of Predisability Monthly Earnings, return-to-work earnings, and other income benefits. After 24 months, Monthly Benefit reduced by 50% of earnings while Disabled."
}
]
},
{
"serviceName": "Rehabilitation Incentive",
"details": [
{
"description": "10% increase in Monthly Benefit if participating in an approved Rehabilitation Program."
}
]
},
{
"serviceName": "Family Care Incentive",
"details": [
{
"description": "Up to $400 per month for eligible Family Care expenses for each eligible family member during the first 24 months of benefit payments."
}
]
},
{
"serviceName": "Moving Expense Incentive",
"details": [
{
"description": "Reimbursement for moving expenses if moving is recommended as part of a Rehabilitation Program."
}
]
}
]
},
{
"category": "Conditions and Limitations",
"services": [
{
"serviceName": "Pre-Existing Condition",
"details": [
{
"description": "Received medical treatment, care, or services for a diagnosed condition; or took prescribed medication for a diagnosed condition in the 3 months immediately prior to the effective date of coverage. Not covered for Disability caused or substantially contributed to by a Pre-existing Condition in the first 12 months after the effective date."
}
]
},
{
"serviceName": "Temporary Recovery",
"details": [
{
"description": "If returning to Active Work before completing the Elimination Period and becomes Disabled again due to the same or related condition, a new Elimination Period is not required if the return is within 30 work days. If the return is greater than 30 work days, a new Elimination Period is required."
}
]
},
{
"serviceName": "Zero Day Residual",
"details": [
{
"description": "Elimination period may be satisfied during part-time employment if continuing to meet the Definition of Disability."
}
]
},
{
"serviceName": "Survivor Benefit",
"details": [
{
"description": "If the employee dies while Disabled, a single sum payment equal to 3 times the last net Monthly Benefit is made to the survivor."
}
]
},
{
"serviceName": "Continuity of Coverage",
"details": [
{
"description": "Provided for groups where this plan will replace an inforce insured plan in force on the day immediately preceding the effective date of this plan."
}
]
},
{
"serviceName": "Cost of Living Freeze",
"details": [
{
"description": "Included in this quote."
}
]
},
{
"serviceName": "Waiver of Premium",
"details": [
{
"description": "Premium payments for Disabled employees are waived while benefits are payable."
}
]
},
{
"serviceName": "Indexing",
"details": [
{
"description": "For determining Partial Disability and calculating Work Incentive, Predisability Earnings adjusted based on the annual rate of increase in the Consumer Price Index for the prior year."
}
]
}
]
},
{
"category": "Specific Limitations",
"services": [
{
"serviceName": "Mental or Nervous Disorders or Diseases",
"details": [
{
"description": "Benefits limited to one occurrence per lifetime maximum of 12 months for schizophrenia, dementia, organic brain disease, and BiPolar Disorder. Combined monthly maximum limitation with other limited conditions."
}
]
},
{
"serviceName": "Chronic Fatigue Syndrome and Related Disorders",
"details": [
{
"description": "Benefits limited to one occurrence per lifetime maximum of 12 months. Combined monthly maximum limitation with other limited conditions."
}
]
},
{
"serviceName": "Neuromuscular, Musculoskeletal or Soft Tissue Disorder",
"details": [
{
"description": "Benefits limited to one occurrence per lifetime maximum of 12 months. Combined monthly maximum limitation with other limited conditions."
}
]
},
{
"serviceName": "Alcohol, Drug or Substance Abuse or Addiction",
"details": [
{
"description": "Benefits limited to one occurrence per lifetime maximum of 12 months. Combined monthly maximum limitation with other limited conditions."
}
]
}
]
}
]
},
{
"planName": "Disability",
"coveredServices": [
{
"category": "Exclusions",
"services": [
{
"serviceName": "We will not pay for any Disability caused or contributed to by:",
"details": [
{
"description": "War, whether declared or undeclared, or act of war, insurrection, rebellion, or terrorist act;",
"benefit": "Not Covered"
},
{
"description": "Your active participation in a riot;",
"benefit": "Not Covered"
},
{
"description": "Intentionally self-inflicted injury;",
"benefit": "Not Covered"
},
{
"description": "Attempted suicide;",
"benefit": "Not Covered"
},
{
"description": "Commission of or attempt to commit a felony.",
"benefit": "Not Covered"
}
]
}
]
}
]
},
{
"planName": "Long Term Disability Coverage",
"rates": {
"rateTables": [
{
"rateGuarantee": "Flat 10.00%",
"rows": [
{
"description": "Broker Commissions",
"monthlyRate": 10,
"estimatedMonthlyCost": null,
"estimatedAnnualCost": null
}
]
}
]
},
"coveredServices": [
{
"category": "Disability Benefits",
"services": [
{
"serviceName": "Rehabilitation Program Participation",
"details": [
{
"description": "Disability benefit payments will end on the date the employee ceases or refuses to participate in a Rehabilitation Program that MetLife requires.",
"benefit": null,
"frequency": null,
"copay": null,
"allowance": null,
"coveredFor": null
}
]
},
{
"serviceName": "Reductions",
"details": [
{
"description": "Benefits will be reduced by income and recoveries paid from certain other sources including but not limited to: any disability benefits under Federal Social Security Act, or any similar plan or act; temporary disability benefits under a workers' compensation law; amounts under any other occupational disease law; any disability benefits under any state compulsory/statutory benefit law; any government retirement system, including but not limited to the California State Teachers Retirement System (CalSTRS) and/or the California Public Employee Retirement System (CalPERS) and/or the Federal Employee Retirement System (FERS); the Policyholder's retirement plan; any retirement benefits under: Federal Social Security Act, or any similar plan or act; third party liability payments by judgment, settlement or otherwise (minus attorneys' fees); sick pay; any salary continuation, personal time off, and annual leave pay.",
"benefit": null,
"frequency": null,
"copay": null,
"allowance": null,
"coveredFor": null
}
]
}
]
}
]
},
{
"planName": "Digital Estate Planning",
"coveredServices": [
{
"category": "Estate Planning Services",
"services": [
{
"serviceName": "Online Estate Planning",
"details": [
{
"description": "Automatically included with Supplemental Life, Group Variable Universal Life and Group Universal Life. Offers unlimited access to create and execute key estate planning documents online by answering a few simple questions.",
"coveredFor": "Not available for customers sitused in FL or located in GU, PR, and VI. Not included with dependent life coverages or certain GUL/GVUL policies. Domestic Partnerships are not currently supported, however, members in a domestic partnership may use a MetLife Legal Plans attorney for their planning needs. Online Notary is not available in all states."
}
]
},
{
"serviceName": "Group Legal Plans",
"details": [
{
"description": "Provided by MetLife Legal Plans, Inc., Cleveland, OH. In certain states, provided through insurance coverage underwritten by Metropolitan Property and Casualty Insurance Company and Affiliates, Warwick, RI."
}
]
}
]
},
{
"category": "Online Will Preparation",
"services": [
{
"serviceName": "WillsCenter.com",
"details": [
{
"description": "Online will prep service offered through SmartLegalForms, Inc., available to all customers at no charge."
}
]
}
]
}
]
},
{
"planName": "U.S. Business Intermediary and Producer Compensation Notice",
"rates": {
"rateTables": [
{
"rateGuarantee": "The supplemental compensation percentage may vary from year to year, but will not exceed 8% under the current supplemental compensation plan.",
"rows": [
{
"description": "Base compensation",
"estimatedAnnualCost": 0
},
{
"description": "Supplemental compensation",
"estimatedAnnualCost": 0
}
]
}
]
},
"coveredServices": [
{
"category": "Compensation Types",
"services": [
{
"serviceName": "Base Compensation",
"details": [
{
"description": "Payable as a percentage of premium or a fixed dollar amount. May vary from case to case and may change upon renewal."
}
]
},
{
"serviceName": "Supplemental Compensation",
"details": [
{
"description": "Ranges from 0% to 8% of premium under the current plan. Based on various factors including number of products sold, premium volume, persistency percentage, block growth, and premium growth during a one-year period."
}
]
}
]
},
{
"category": "Other Compensation",
"services": [
{
"serviceName": "Service Fees",
"details": [
{
"description": "May include service fees for sale, servicing, and/or renewal of products."
}
]
},
{
"serviceName": "Return on Premiums Collected",
"details": [
{
"description": "Intermediary may earn a return on premiums collected from clients."
}
]
},
{
"serviceName": "Other Relationships",
"details": [
{
"description": "May involve payment of compensation and benefits not directly related to the client's relationship with MetLife, such as insurance and employee benefits exchanges, enrollment firms and platforms, sales contests, consulting agreements, participation in an insurer panel, or reinsurance arrangements."
}
]
}
]
}
]
},
{
"planName": "Non-U.S. Coverage",
"rates": {
"rateTables": []
},
"coveredServices": [
{
"category": "Underwriting Assumptions",
"services": [
{
"serviceName": "Non-U.S. Coverage Information",
"details": [
{
"description": "When providing information concerning an eligible group insurance policy issued or proposed to your affiliate or subsidiary outside the United States by a MetLife affiliate or by other locally licensed insurers that are members of the MAXIS Global Benefits Network (MAXIS GBN), New York insurance law requires the person providing the information to be licensed as an insurance broker. In this capacity, the information provided to you will only be on behalf of such insurers and not on behalf of MetLife or any other insurer that is not a member of MAXIS GBN. Please note that while MetLife is a member of MAXISGBN and is licensed to transact insurance business in New York, the other MAXIS GBN member insurers are not licensed or authorized to do business in New York. The group insurance policies they issue are for coverage outside the United States and are governed by the laws of the country they were issued in. These policies have not been approved by the New York Superintendent of Financial Services, are not subject to all of the laws of New York, and are not protected by the New York State Guaranty Fund.",
"benefit": "Coverage outside the United States governed by the laws of the issuing country.",
"coveredFor": "Affiliates or subsidiaries outside the United States"
}
]
}
]
}
]
}
],
"Error": "JSON could not be decoded",
"Content": "# Summary of Benefits\n\nVISION - PPO - VSP Choice Network\n\n<table><tr><td colspan=\"3\"></td></tr><tr><td>Class Description</td><td colspan=\"2\">All Active Full Time Employees (30 Hours)</td></tr><tr><td>Plan Name</td><td colspan=\"2\">M150A-10/15</td></tr><tr><th>Reimbursement</th><th>In-Network Coverage (Using a Network Provider)</th><th>Out-of-Network Reimbursement (Using a Non-Network Provider)</th></tr><tr><td>Eye Examination</td><td></td><td></td></tr><tr><td>Comprehensive exam of visual functions and prescription of corrective eyewear.</td><td>$10 copay</td><td>$45 allowance</td></tr><tr><td>Retinal Imaging This screening is used to take pictures of the inside of the eye particularly the retina to look for possible changes.</td><td>Up to $39 copay</td><td>Applied to the exam allowance</td></tr><tr><td>Materials / Eyewear (Either Glasses or Contacts)</td><td></td><td></td></tr><tr><td>Standard Corrective Lenses Single vision</td><td>$15 copay</td><td>$30 allowance</td></tr><tr><td>Lined bifocal</td><td>$15 copay</td><td>$50 allowance</td></tr><tr><td>Lined trifocal</td><td>$15 copay</td><td>$65 allowance</td></tr><tr><td>Lenticular</td><td>$15 copay</td><td>$100 allowance</td></tr></table>\n\nMetLife Cost & Benefits Summary\n11/4/2022 7:07 AM\n\nPage 38 of 63\n\nP3184230.1435241.\n\nMetLife\n\n<table><tr><td>Standard Lens Enhancement</td><td></td><td></td></tr><tr><td>Ultraviolet coating</td><td>Covered in Full</td><td>Applied to the allowance for the applicable corrective lens</td></tr><tr><td>Standard Polycarbonate (child up to age 18)</td><td>Covered in Full</td><td>Applied to the allowance for the applicable corrective lens</td></tr><tr><td>Additional Lens Enhancements</td><td></td><td></td></tr><tr><td>Progressive Standard</td><td>Up to $55 copay</td><td>$50 allowance</td></tr><tr><td>Progressive Premium/Custom</td><td>Premium: Up to $95-$105 copay Custom: Up to $150-$175 copay</td><td>$50 allowance</td></tr><tr><td>Standard Polycarbonate (adult)</td><td>Single Vision: Up to $31 copay Multifocal: Up to $35 copay</td><td>Applied to the allowance for the applicable corrective lens</td></tr><tr><td>Scratch-resistant coating (variable by type)</td><td>Up to $17 - $33 copay</td><td>Applied to the allowance for the applicable corrective lens</td></tr><tr><td>Tints (plastic lenses)</td><td>Pink I &amp; II: $0 copay Solid Plastic: $15 Copay Plastic Gradient Dye: $17 Copay</td><td>Applied to the allowance for the applicable corrective lens</td></tr><tr><td>Anti-reflective coating (variable by type)</td><td>Up to $41 - $85 copay</td><td>Applied to the allowance for the applicable corrective lens</td></tr><tr><td>Photochromic (variable by type)</td><td>Up to $47 - $82 copay</td><td>Applied to the allowance for the applicable corrective lens</td></tr><tr><td>Frame Allowance (You will receive an additional 20% off any amount that you pay over your allowance. This offer is available from all participating locations except Costco, Walmart and Sam's Club.) Costco, Walmart and Sam's Club</td><td>$150 allowance $150 allowance on featured frames $70 allowance</td><td>$70 allowance</td></tr><tr><td>Contact Lenses</td><td></td><td></td></tr><tr><td>Elective</td><td>$150 allowance</td><td>$105 allowance</td></tr><tr><td>Necessary</td><td>Covered in full after eyewear copay</td><td>$210 allowance</td></tr><tr><td>Contact Fitting and Evaluation</td><td>Standard or Premium fit: Copay not to exceed $60</td><td>Applied to the contact lens allowance</td></tr></table>\n<table><tr><td>Value Added Features</td></tr></table>\n\nMetLife Cost & Benefits Summary\n11/4/2022 7:07 AM\n\nPage 39 of 63\n\nP3184230.1435241.\n\nMetLife\n\n<table><tr><td>Additional Savings on Glasses and Sunglasses 1</td><td>Get 20% off the cost for additional pairs of prescription glasses and non-prescription sunglasses, including lens enhancements. At times, other promotional offers may also be available.</td></tr><tr><td>Laser Vision correction2</td><td>Savings averaging 15% off the regular price or 5% off a promotional offer for laser surgery including PRK, LASIK and Custom LASIK. Offer is only available at MetLife participating locations.</td></tr></table>\n\n1Member costs for listed lens enhancements will be limited to copays that MetLife has negotiated with participating providers. These copays can be viewed by members after enrollment at www.metlife.com/mybenefits. 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 the availability of lens enhancements and pricing prior to receiving services. Additional discounts may not be available in certain states.\n\n2 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. Laser vision care discounts are only available from participating locations.\n\n<table><tr><th>Vision</th><th>Rate per Employee</th><th>Lives</th><th>Est Monthly Premium</th><th>Est Annual Premium</th></tr><tr><td>Employee Only</td><td>$7.98</td><td>50</td><td rowspan=\"5\">$719</td><td rowspan=\"5\">$8,633</td></tr><tr><td>Employee + Spouse</td><td>$16.01</td><td>6</td></tr><tr><td>Employee + Child(ren)</td><td>$13.56</td><td>5</td></tr><tr><td>Employee + Family</td><td>$22.36</td><td>7</td></tr><tr><td>Total</td><td></td><td>68</td></tr></table>\n<table><tr><td>Rates are guaranteed from January 1, 2023 - December 31, 2024 (24)</td></tr></table>\n\nMetLife Cost & Benefits Summary\n11/4/2022 7:07 AM\n\nPage 40 of 63\n\nP3184230. 1435241.\n\nMetLife"
}
]
}
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