WIXLIB

With respect to TRICARE-eligible individuals, family members include your spouse,unremarried widow, unremarried widower, unmarried child, an unremarried former spousewho meets the U.S Department of Defense's 20-20-20 or 20-20-15 eligibilityrequirements, and certain unmarried persons placed in your legal custody by a court.Children include legally adopted children, stepchildren, and pre-adoptive children.Children and dependent unmarried persons must be under age 21 if they are not a student,under age 23 if they are a full-time student, or incapable of self-support because of amental or physical incapacity.Not EligibleThe following persons are not eligible to enroll in FEDVIP, regardless of FEHB eligibilityor receipt of an annuity or portion of an annuity: Deferred annuitants Former spouses of employees or annuitants. Note: Former spouses of TRICAREeligible individuals may enroll in a FEDVIP vision plan. FEHB Temporary Continuation of Coverage (TCC) enrollees Anyone receiving an insurable interest annuity who is not also an eligible familymember Active duty uniformed service members. Note: If you are an active duty uniformedservice member, your dental and vision coverage will be provided by TRICARE.Your family members will still be eligible to enroll in the TRICARE Dental Plan(TDP).2021 The MetLife Federal Vision Plan5Enroll at BENEFEDS.com

Section 2 EnrollmentEnroll ThroughBENEFEDSYou must use BENEFEDS to enroll or change enrollment in a FEDVIP plan. BENEFEDS isa secure enrollment website (www.BENEFEDS.com) sponsored by OPM. If you do not haveaccess to a computer, call 1-877-888-FEDS (1-877-888-3337), TTY number 1-877-889-5680 toenroll or change your enrollment.If you are currently enrolled in FEDVIP and do not want to change plans or options, yourenrollment will continue automatically. Please Note: your plans' premiums may change for2021.Note: You cannot enroll or change enrollment in a FEDVIP plan using the Health Benefits ElectionForm (SF 2809) or through an agency self-service system, such as Employee Express, PostalEase,EBIS, MyPay, or Employee Personal Page. However, those sites may provide a link toBENEFEDS.EnrollmentTypesSelf Only: A Self Only enrollment covers only you as the enrolled employee or annuitant. Youmay choose a Self Only enrollment even though you have a family. However, your familymembers will not be covered under FEDVIP.Self Plus One: A Self Plus One enrollment covers you as the enrolled employee or annuitant plusone eligible family member whom you specify. You may choose a Self Plus One enrollment eventhough you have additional eligible family members, but the additional family members will not becovered under FEDVIP.Self and Family: A Self and Family enrollment covers you as the enrolled employee or annuitantand all of your eligible family members. You must list all eligible family members when enrolling.Dual EnrollmentIf you or one of your family members is enrolled in or covered by one FEDVIP plan, that personcannot be enrolled in or covered as a family member by another FEDVIP plan offering the sametype of coverage; i.e., you (or covered family members) cannot be covered by two FEDVIP dentalplans or two FEDVIP vision plans.Opportunities toEnroll or ChangeEnrollmentOpen SeasonIf you are an eligible employee, annuitant, or TRICARE-eligible individual, you may enroll in adental and/or vision plan during Open Season, November 9, through December 14, 2020(midnight, EST). Coverage is effective January 1, 2021.During future annual Open Seasons, you may enroll in a plan, or change or cancel your dental and/or vision coverage. The effective date of these Open Season enrollments and changes will be setby OPM. If you want to continue your current enrollment, do nothing. Your enrollmentcarries over from year to year, unless you change it.New hire/Newly eligibleYou may enroll within 60 days after you become eligible as: a new employee; a previously ineligible employee who transferred to a covered position; a survivor annuitant if not already covered under FEDVIP; or an employee returning to service following a break in service of at least 31 days. a TRICARE-eligible individualYour enrollment will be effective the first day of the pay period following the one in whichBENEFEDS receives and confirms your enrollment.Qualifying Life Event2021 The MetLife Federal Vision Plan6Enroll at BENEFEDS.com

A qualifying life event (QLE) is an event that allows you to enroll, or if you are already enrolled,allows you to change your enrollment outside of an Open Season.The following chart lists the QLEs and the enrollment actions you may take:QualifyingLife EventMarriageAcquiring aneligiblefamilymember(non-spouse)Losing acoveredfamilymemberLosing otherdental/visioncoverage(eligible orcoveredperson)Moving outof regionalplan's serviceareaGoing onactivemilitary duty,nonpaystatus(enrollee orspouse)Returning topay statusfrom activemilitary duty(enrollee orspouse)Returning topay statusfrom Leavewithout payAnnuity/compensationrestoredTransferringto an eligibleposition*2021 The MetLife Federal Vision PlanFrom NotEnrolled eEnrollmentTypeNoNoCancelNoNoChange fromOne Plan NoNoYesNoYesNoNoNoNoYes Yes oll at BENEFEDS.com

*Position must be in a Federal agency that provides dental and/or vision coverage with 50percent or more employer-paid premium.The timeframe for requesting a QLE change is from 31 days before to 60 days after the event.There are two exceptions: There is no time limit for a change based on moving from a regional plan’s service area; and You cannot request a new enrollment based on a QLE before the QLE occurs, except forenrollment because of a loss of dental or vision insurance. You must make the change no laterthan 60 days after the event.Generally, enrollments and enrollment changes made based on a QLE are effective on the firstday of the pay period following the one in which BENEFEDS receives and confirms theenrollment or change. BENEFEDS will send you confirmation of your new coverage effectivedate.Once you enroll in a plan, your 60-day window for that type of plan ends, even if 60 calendardays haven’t yet elapsed. That means once you have enrolled in either a dental or a vision plan,you cannot change or cancel that particular enrollment until the next Open Season, unless youexperience a QLE that allows such a change or cancellation.Canceling an enrollmentYou may cancel your enrollment only during the annual Open Season. An eligible familymember’s coverage also ends upon the effective date of the cancellation.Your cancellation is effective at the end of the day before the date OPM sets as the Open Seasoneffective date.When CoverageStopsCoverage ends for active and retired Federal, U.S. Postal employees, and TRICARE-eligibleindividuals when you: no longer meet the definition of an eligible employee, annuitant, or TRICARE-eligibleindividual; as a Retired Reservist you begin active duty; as sponsor or primary enrollee leaves active duty begin a period of non-pay status or pay that is insufficient to have your FEDVIP premiumswithheld and you do not make direct premium payments to BENEFEDS; are making direct premium payments to BENEFEDS and you stop making the payments; cancel the enrollment during Open Season; a Retired Reservist begins active duty; or the sponsor or primary enrollee leaves active duty.Coverage for a family member ends when: you as the enrollee lose coverage; or the family member no longer meets the definition of an eligible family member.Continuation ofCoverageUnder FEDVIP, there is no 31-day extension of coverage. The following are also NOTavailable under the FEDVIP plans: Temporary Continuation of Coverage (TCC); spouse equity coverage; or right to convert to an individual policy (conversion policy).2021 The MetLife Federal Vision Plan8Enroll at BENEFEDS.com

FSAFEDS/HighDeductible HealthPlans and FEDVIPIf you are planning to enroll in an FSAFEDS Health Care Flexible Spending Account(HCFSA) or Limited Expense Health Care Flexible Spending Account (LEX HCFSA),you should consider how coverage under a FEDVIP plan will affect your annual expenses, andthus the amount that you should allot to an FSAFEDS account. Please note that insurancepremiums are not eligible expenses for either type of FSA.If you have an HCFSA or LEX HCFSA FSAFEDS account and you haven’t exhausted yourfunds by December 31st of the plan year, FSAFEDS can automatically carry over up to 550 ofunspent funds into another health care or limited expense account for the subsequent year. To beeligible for carryover, you must be employed by an agency that participates in FSAFEDS andactively making allotments from your pay through December 31. You must also activelyreenroll in a health care or limited expense account during the NEXT Open Season to becarryover eligible. Your reenrollment must be for at least the minimum of 100. If you do notreenroll, or if you are not employed by an agency that participates in FSAFEDS and activelymaking allotments from your pay through December 31st, your funds will not be carried over.Because of the tax benefits an FSA provides, the IRS requires that you forfeit any money forwhich you did not incur an eligible expense and file a claim in the time period permitted. This isknown as the “Use-it-or-Lose-it” rule. Carefully consider the amount you will elect.For a health care or limited expense account, each participant must contribute a minimum of 100 to a maximum of 2,750.Current FSAFEDS participants must re-enroll to participate next year. See www.fsafeds.com orcall 1-877-FSAFEDS (372-3337) or TTY: 1-866-353-8058. Note: FSAFEDS is not open toretired employees, or to TRICARE eligible individuals.If you enroll or are enrolled in a high deductible health plan with a health savings account(HSA) or health reimbursement arrangement (HRA), you can use your HSA or HRA to pay forqualified dental/vision costs not covered by your FEHB and FEDVIP plans.Using your FSA pre-tax dollars for your eyecare and eyewear needs is a great way to get moreout of your benefit dollar.Using your FSAFEDS account for your eyecare and eyewear expenses is simple: Visit your provider for your routine eye examination and eyewear Pay any out-of-pocket expenses Submit your expenses for reimbursement.2021 The MetLife Federal Vision Plan9Enroll at BENEFEDS.com

Section 3 How You Obtain BenefitsIdentification Cards/EnrollmentConfirmationWhen you enroll for the first time, you will receive a welcome letter along with anidentification card ("ID Card"). It is important to bring your FEDVIP and FEHB ID cardto every vision appointment because most FEHB plans offer some level of vision benefitsseparate from your FEDVIP coverage. Presenting both ID cards can ensure that youreceive the maximum allowable benefit under each Program. If you require a replacementID card, you will be able to view and print your ID card via MyBenefits after enteringMetLife.com/FEDVIP-Vision. An ID card is neither a guarantee of benefits nor does yourprovider need it to render vision services. Your provider may call (800) 615-1883 toconfirm your enrollment in the Plan and the benefits available to you.Where You Get CoveredCareYou can obtain care from any licensed vision provider. However, you will get the most outof your benefits when you see a MetLife Vision in-network provider.Plan ProvidersWe list our In-Network Plan providers on our website at: MetLife.com/FEDVIP-Vision.When you make your appointment please inform the provider's office you are enrolled inthe FEDVIP MetLife Vision Program and that you wish to use your In-Network benefits.This will also serve to confirm that the provider is a MetLife network provider. Yourprovider may contact customer service at (800) 615-1883.In-NetworkCare that you receive from a MetLife Vision provider is considered In-Network. MetLife’snetwork consists of independently credentialed and contracted providers. To find aMetLife Vision provider in your area go to: MetLife.com/FEDVIP-Vision. You may alsocontact customer service at (888) 865-6854.Out-of-NetworkCare that you receive from a licensed provider that does not participate in the MetLifeVision Plan is considered Out-of-Network. To find an In-Network MetLife Visionprovider in your area go to: MetLife.com/FEDVIP-Vision. You may also contact customerservice at (888) 865-6854FEHB First PayorIf you have vision coverage through your FEHB plan and coverage under FEDVIP, yourFEHB plan will be the first payor of any benefit payments. When services are renderedby a provider, who participates with both your FEHB and your FEDVIP plan, the FEDVIPplan allowance will be the prevailing charge in these cases. We are responsible forfacilitating the process with the primary FEHB payor. You are responsible for thedifference between the FEHB and FEDVIP benefit payments and the FEDVIP planallowance.Coordination of BenefitsIFYou have vision coverage through a nonFEHB plan and MetLife Vision coverageunder FEDVIP (covered through a spouse)If your covered dependent child hascoverage through a non-FEHB plan andMetLife Vision coverage under FEDVIP.Limited Access AreaTHENMetLife Vision is the primary payor andyour non-FEHB plan is secondary.The parent's plan whose birthday occursfirst in the calendar year is primary. Ifbirthday's are the same (disregarding theyear) for both parents, the primary payor isthe plan that has provided coverage thelongest.If you live in an area that does not have adequate access to a MetLife Vision networkprovider and you receive covered services from an Out-of-Network provider, MetLife willreimburse you up to the plan allowance. You are responsible for any difference betweenthe amount billed and MetLife's payment. Follow Out-of-Network claim submissioninstructions. The determination of limited access is based on a ratio of Federal eligibles toMetLife Vision providers as well as the distance to MetLife Vision providers within theparticipants USPS ZIP code. MetLife reviews the limited access areas quarterly to ensureyou have adequate access to our in-network vision providers.2021 The MetLife Federal Vision Plan10Enroll at BENEFEDS.com

Plan Allowance: The maximum benefit payment for services provided in areas notmeeting the access standards are shown in the chart below. You are responsible for chargesbilled over the amounts shown.up to 65Eye ExamLenses:Single visionLined bifocalsLined trifocalsLenticularFramesContact Lenses:ElectiveNecessaryPre-Authorizationup to 55up to 75up to 95up to 125Up to 120up to 105up to 210Pre-authorization is only required for payment of Low Vision benefits. See section 5 forfurther details regarding Low Vision coverage.2021 The MetLife Federal Vision Plan11Enroll at BENEFEDS.com

Section 4 Your Cost for Covered ServicesThis is what you will pay out-of-pocket for covered services:Co-paysA co-pay is a fixed amount of money you pay to the provider when you receive services.For Example: Both the High and Standard options do not have a co-pay for routine eyeexaminations. However, the Standard option has a 20 materials co-pay and the Highoption does not have a materials co-pay. A materials co-pay is a single payment thatapplies to the purchase of standard eyeglasses (lenses and/or frames). There may be copays for optional lens treatments or non-standard services. Please refer to Section 5 of thisbrochure for additional detail.Benefit FrequencyBoth the Standard and High options allow one routine examination every calendar year;one pair of eyeglass lenses every calendar year; one eyeglass frame every calendar year. Acontact lens benefit is available every calendar year in place of eyeglassesIn-Network ServicesYou maximize your benefits when you visit a MetLife Vision in-network doctor. Your eyeexam and prescription glasses or contacts are covered after any co-payments. You can alsoreceive 20% savings on any out-of-pocket costs over your frame allowance and anaverage 20% - 25% savings on other lens enhancements. (Based on applicable laws.Benefits may vary by doctor locations. See your doctor for pricing.) There are also noclaim forms to submit when you see an In-Network doctor.Out-of-Network ServicesMetLife will partially reimburse services performed by out-of-network providers. Refer tothe Summary of Benefits section. You must pay the bill at the time of service and submitthe claim to MetLife for partial reimbursement.When you visit an out-of-network provider, you will be reimbursed according to thefollowing schedule:up to 45Eye ExamLenses:Single visionLined bifocalsLined trifocalsLenticularFramesup to 45up to 65up to 85up to 125Up to 55 in the standard option or up to 70 in the high optionContact Lenses:ElectiveNecessary2021 The MetLife Federal Vision Planup to 105up to 21012Enroll at BENEFEDS.com

Section 5 Vision Services and SuppliesImportant things you should keep in mind about these benefits:Please remember that all benefits are subject to the provisions, including limi

This brochure describes the benefits of The MetLife Federal Vision Plan under Metropolitan Life Insurance Company (MetLife) contract OPM02-FEDVIP-02AP-12 with OPM, as authorized by the FEDVIP law. The address for our administrative office is: MetLife . 501 US Highway 22 . Bridgewater, NJ 08807 (888) 865-6854 TDD (888) 260-5376 . MetLife.com .