MetLife Vision (SEBB) Certificate of Coverage (COC) Washington employees

This benefits book describes what is covered as a SEBB member under MetLife Vision, including vision services and specific services not covered by the plan. Finding preferred providers and how much you’ll pay, including deductibles, coinsurance, and copays.

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MetLife Vision (SEBB) preauthorization requirements

Preauthorization requirements for MetLife Vision plan. Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

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PEBB Continuation Coverage (COBRA) election/change form 2020

50-245F

Use this form to enroll in or change your enrollment options for COBRA coverage.

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PEBB Continuation Coverage (Unpaid Leave) election/change form 2020

50-135F

Use this form to enroll in or change your enrollment options for PEBB Continuation Coverage (Unpaid Leave).

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PEBB Continuation Coverage Election Notice

50-801

This is the booklet you will receive when your Public Employees Benefits Board (PEBB) health coverage ends. This booklet explains how you and your dependents can continue your PEBB health coverage. To continue PEBB health coverage, you must complete the enclosed form(s) and follow the instructions.

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PEBB Continuation Coverage monthly premiums 2020

50-300R

These are the Public Employees Benefits Board (PEBB) medical plans offered for PEBB Continuation Coverage subscribers in 2020. To the right of each plan are the monthly premiums for an individual subscriber, subscriber and spouse,* subscriber with child(ren), and subscriber, spouse*, and child(ren). These premiums do not include the monthly premium surcharges, if applicable to your account.

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PEBB Employee Enrollment Guide 2020

50-100

This guide explains everything about PEBB benefits for public employees.

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PEBB employee request for review/notice of appeal

Use this form if you are requesting an appeal of a decision.

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PEBB nondiscrimination statement and language access notice

57-401

This nondiscrimination statement describes how the PEBB Program and its contracted health plans comply with applicable federal civil rights laws.

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PEBB retiree/Continuation Coverage notice of appeal

Use this form if you are requesting an appeal of a decision.

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