Metropolitan Life Insurance Company200 Park AvenueNew York, NY 10166www.metlife.com

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OVERVIEW

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Take advantage of the valuablebenefits available to you throughyour employer and enroll today!

Empire Southwest LLC

- Dental Insurance- Vision Benefits

Dental BenefitsProduct Overview

Dental problems can be unpredictable and expensive. For example, did you know that a crown can cost up to $1,451?1

Dental insurance not only helps you pay for your dental care, it can help prevent problems.When your preventive care is covered, you’re more likely to go for cleanings and checkups — this can help you avoid problems before they become too costly or complicated.Dental insurance protects your peace of mind.Why your PPO is so great:More to smile about

See whatever dentist you want. Even if your dentist isn’t in the network, you can go to him or her — just remember you usually save more when you stay in network.2

You have a wide choice of participating dentists. Plus, dentists in the network are carefully selected.3

Take advantage of negotiated fees that are typically15–45% less than average charges in the same area.4

Your dentist usually handles claims — which meansless paperwork for you.Find out what you’ll pay ahead of time. Your dentist can request a pre-treatment estimate for any service that is more than $300. This helps you manage your costs and care.5

Why dental insurance makes senseWhat does dental insurance protect?

Understanding your PPO plan is as easy as 1, 2, 3:

1. Understand the types of proceduresDifferent plans pay different percentages for these procedures. And, while they may change depending on your plan, the definitions below usually describe the standard service types.

Preventive Care — cleanings, X-rays and examsBasic Care — fillings and extractionsMajor Care — bridges, crowns and dentures

2. Know the percentagesLook on your Plan Summary — next to each of these categories is a percentage. That’s thepercentage MetLife will pay for covered services,and you’ll be responsible for the rest.

3. Look at out-of-pocket costsNext, check to see if the plan has an Annual Deductible — that’s the amount you’ll have to pay each year before your benefits kick in.Also, check the Annual Maximum Benefit — that’s the most MetLife will pay in a year. There’s also a difference between the Individual Maximum (for each family member) and the Family Annual Maximum (which applies to the total that is paid for everyone in your family).

1 Based on MetLife data for a crown (D2740) in ZIP code 19151. This cost reflects the 80th percentile Reasonable and Customary (R&C) fee. R&C fees are calculated based on the lowest of 1) the dentist’s actual charge, 2) the dentist’s usual charge for the same or similar services or 3) the usual charge of most dentists in the same geographic area for the same or similar services as determined by MetLife. This example is used for informational purposes only. Fees in your area may be different.2 Savings from enrolling in the MetLife Preferred Dentist Program will depend on various factors, including how often participants visit the dentist and the costs for services rendered.3 Certain providers may participate with MetLife through an agreement that MetLife has with a vendor. Providers available through a vendor are subject to the vendor’s credentialing process and requirements, not MetLife’s. If you should have any questions, contact MetLife Customer Service.4 Negotiated Fees refer to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any co-payments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change.5 MetLife strongly recommends that you have your dentist submit a pretreatment estimate to MetLife if the cost is expected to exceed $300. When your dentist suggests treatment, have him or her send a claim form, along with the proposed treatment plans and supporting documentation, to MetLife. An explanation of benefits (EOB) will be sent to you and the dentist detailing an estimate of what services MetLife will cover and at what payment level. Actual payments may vary from the pretreatment estimate depending upon annual maximums, deductibles, plan frequency limits and other plan provisions at time of payment.

Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. Please contact MetLife or your plan administrator for complete details.

Metropolitan Life Insurance Company200 Park Avenue, New York, NY 10166© 2016 METLIFE, INC.L0316459737[exp0417][All States][DC,GU,MP,PR,VI]

Now that you know the benefits of havingDental Insurance, learn more and enroll today!

Understanding Your Dental Plan

The Preferred Dentist Program was designed to help you get the dental care you need and help lower your costs. You get benefits for a wide range of covered services — both in and out of the network. The goal is to deliver affordable protection for a healthier smile and a healthier you. You also get great service and educational support to help you stay on top of your care. Freedom of choice to go to any dentist. You have the flexibility to visit any dentist — your dentist — and receive coverage under the plan. Just remember that non-participating dentists haven’t agreed to charge negotiated fees. That means you usually save more dental dollars when you go to a participating dentist. If you prefer to stay in the network, there are thousands of general dentists and specialists to choose from nationwide — so you are sure to find one who meets your needs. Plus, all participating dentists go through a rigorous selection and review process.1 This way you don’t need to worry about quality. You also don’t need any referrals. To check out the general dentists and specialists in the PDP Plus network, visit www.metlife.com/dental. Additional savings when you visit participating dentists. Your out-of-pocket costs are usually lower when you visit network dentists. That’s because they have agreed to accept negotiated fees that are typically 15 to 45% less than average dental charges in the same community. This may help lower your final costs and stretch your plan maximum. Negotiated fees may even extend to non-covered services and services provided after you've reached the plan maximum.2

Service where and when you want it. MyBenefits, your secure self-service website, is available 24/7.3 You can use the site to get estimates on care or check coverage and claim status. Plus, if you are on the go and need to find an in-network provider, view a claim or see your ID card, there’s an app for that.4 Search “MetLife” at the iTunes App Store or Google Play to download the app.5 Educational tools and resources. The right dental care is an essential part of good overall health. That’s why you and your dentist get resources to help make informed decisions about your oral health. You’ll find a range of topics on our online dental education website, www.oralfitnesslibrary.com. Read up on the link between dental and overall health, kids’ dental health and more. You can also put your oral health to the test by taking an online risk assessment.

Understanding Your Dental Plan (continued)

The information below explains certain terms to make it easier for you to understand and use your benefits.

1. Coverage Types. Dental procedures are grouped into the following categories: Preventive (Type A), Basic Restorative (Type B), Major Restorative (Type C), and Orthodontia (Type D). Your group’s plan determines how each procedure is categorized (Type A, B, C, D). Generally, benefits for Type A procedures pay at the highest benefits level because they prevent and diagnose dental disease.

2. Co-insurance. The co-insurance

percentage helps determine what your out-of-pocket costs will be for each coverage type. Each Type − A, B, C, and D − has a pre-set percentage that represents what your plan will reimburse for the services in each category. Your total out-of-pocket responsibility is subject to any deductibles, benefit maximums, plan provisions, if you receive out-of-network services, and your plan’s basis for reimbursement. Please see your Dental Plan Benefits Summary for more information. Copay. This is the fixed amount that you have to pay for covered services. Copayment amounts are listed in the Procedure Charge Schedule that you received with your Dental Benefits Plan Summary. Your total out-of-pocket responsibility is subject to any deductibles, benefit maximums, plan provisions, if you receive out-of-network services, and your plan’s basis for reimbursement. Please see your Dental Plan Benefits Summary and Procedure Charge Schedule for more information.

3. Deductible. This is the amount you must pay out-of-pocket before benefit payments will be made by

the plan. For most plans, the deductible amounts for in-network services are less than the amount for out-of-network services. Many plans do not require that a deductible be met for Type A services.

4. Annual Maximum Benefit. This is the total amount the plan will pay in the plan year. Once this

amount is reached, no further benefits will be paid. However, you may still be eligible to receive services at the negotiated fee rates when visiting a participating dentist.2

5. Orthodontia Lifetime Maximum. Not all plans cover Orthodontia Treatment. If your plan covers Orthodontia there is a Lifetime Maximum that is applicable only to Orthodontia. This does not affect your Annual Maximum Benefit for Types A, B, and C coverages. The Lifetime Maximum is the total amount the plan will pay for orthodontic services for each covered person (subject to any plan age limitations). Once this amount is reached, no further benefits will be paid. However, you may still be eligible to receive services at the negotiated fee amounts when visiting a participating dentist.2

Understanding Your Dental Plan (continued)

Putting it all together – maximizing the value of your dental benefits. Make the most of your benefits — visit a participating dentist to reduce your out-of-pocket costs.

Keep a healthy dental regimen by getting routine exams and cleanings – the cost of preventive services (Type A) is usually less than the cost for fillings, root canals, extractions, etc. – and can help to prevent the need for these higher-cost treatments.

It is recommended that you request a pre-treatment estimate for services that cost more than $300. The estimate will give you an idea of what your out-of-pocket costs will be. To receive a benefit estimate, have your dentist submit a request online at www.metdental.com or by calling 1-877-MET-DDS9 (phone number and website for dental professionals only).

Visit the dental education website at www.oralfitnesslibrary.com for important tools and resources to help you become more informed about dental care.

Remember, dental coverage can be an important part of protecting your health and finances. By using the educational tools and benefits made available to you through this plan, you’ll be better prepared to protect your oral health and your budget.

1. Certain providers may participate with MetLife through an agreement that MetLife has with a vendor. Providers available through

a vendor are subject to the vendor’s credentialing process and requirements, not MetLife's. If you should have any questions, contact MetLife Customer Service.

2. Negotiated fees on non-covered services may not apply in all states. 3. With the exception of scheduled or unscheduled systems maintenance or interruptions, the MyBenefits website is typically

available 24 hours a day, 7 days a week.

4. The features of the MetLife Dental Mobile App are not available for all MetLife Dental Plans.

5. Before using the MetLife Dental Mobile App, you must register at www.metlife.com/mybenefits from a computer. Registration cannot be done from your mobile device.

Like most group benefits programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details. L0415417288[exp0616][All States][DC,GU,MP,PR,VI] Metropolitan Life Insurance Company, New York, NY 10166

Network: PDP Plus

PLAN OPTION 1 Dental Base Plan

PLAN OPTION 2 Dental Buy-Up Plan

Coverage Type In-Network

% of Negotiated Fee*

Out-of-Network % of R&C Fee**

In-Network % of Negotiated

Fee*

Out-of-Network % of R&C Fee**

Type A: Preventive (cleanings, exams, X-rays)

90% 90% 100% 100%

Type B: Basic Restorative (fillings, extractions)

60% 60% 80% 80%

Type C: Major Restorative (bridges, dentures)

40% 40% 50% 50%

Type D: Orthodontia Not Covered Not Covered 50% 50%

Deductible†

Individual $50 $50 $50 $50

Family $150 $150 $150 $150

Annual Maximum Benefit

Per Person $1,000 $1,000 $1,500 $1,500

Orthodontia Lifetime Maximum

Per Person Not Covered Not Covered $2,500 $2,500

Child(ren)’s eligibility for dental coverage is from birth up to age 26. *Negotiated Fee refers to the fees that participating dentists have agreed to accept as payment in full, subject to any copayments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. **R&C fee refers to the Reasonable and Customary (R&C) charge, which is based on the lowest of (1) the dentist’s actual charge, (2) the dentist’s usual charge for the same or similar services, or (3) the charge of most dentists in the same geographic area for the same or similar services as determined by MetLife. †Applies only to Type B & C Services.

MetLife Dental Insurance Plan Summary

 

L i s t o f P r i m a r y C o v e r e d S e r v i c e s & L i m i t a t i o n s The service categories and plan limitations shown represent an overview of your Plan Benefits. This document presents the majority of services within each category, but is not a complete description of the Plan.

Plan Option 1: Dental Base Plan Plan Option 2: Dental Buy-Up Plan

Type A – Preventive How Many/How Often Type A – Preventive How Many/How Often

Prophylaxis (cleanings) One per 6 months Prophylaxis (cleanings) One per 6 months Oral Examinations One per 6 months Oral Examinations One per 6 months Topical Fluoride Applications

One fluoride treatment per 6 months for dependent children up to his/her 19th birthday

Topical Fluoride Applications

One fluoride treatment per 6 months for dependent children up to his/her 19th birthday

X-rays Full mouth X-rays: one per 5 fiscal years Bitewings X-rays: one set per fiscal year for adults; two sets

per fiscal year, separated by 6 months, for children

X-rays Full mouth X-rays: one per 5 fiscal years Bitewing X-rays: one set per fiscal year for adults; two sets

per fiscal year, separated by 6 months, for children Sealants One application of sealant material every 3 fiscal years for

each non-restored, non-decayed 1st and 2nd molar of a dependent child up to his/her 16th birthday

Sealants One application of sealant material every 3 fiscal years for each non-restored, non-decayed 1st and 2nd molar of a dependent child up to his/her 16th birthday

Type B – Basic Restorative How Many/How Often Type B – Basic

Restorative How Many/How Often

Fillings Fillings Simple Extractions Simple Extractions Crown, Denture and Bridge Repair/ Recementations

Repair: once every 12 months Recementations: once every 12 months

Crown, Denture and Bridge Repair/ Recementations

Repair: once every 12 months Recementations: once every 12 months

Endodontics Root canal treatment limited to once per tooth per lifetime Endodontics Root canal treatment limited to once per tooth per lifetime Oral Surgery Oral Surgery General Anesthesia When dentally necessary in connection with oral surgery,

extractions or other covered dental services General Anesthesia When dentally necessary in connection with oral surgery,

extractions or other covered dental services Periodontics Periodontal scaling and root planing once per quadrant,

every 2 fiscal years Periodontal surgery once per quadrant, every 2 fiscal years Periodontal maintenance treatments are limited to 2 times in

1 fiscal year

Periodontics Periodontal scaling and root planing once per quadrant, every 2 fiscal years

Periodontal surgery once per quadrant, every 2 fiscal years Periodontal maintenance treatments are limited to 2 times in

1 fiscal year Space Maintainers Space maintainers for dependent children up to his/her 19th

birthday. Once per tooth area, per lifetime Space Maintainers Space maintainers for dependent children up to his/her 19th

birthday. Once per tooth area, per lifetime Type C – Major Restorative How Many/How Often Type C – Major

Restorative How Many/How Often

Implants Replacement: once every 5 fiscal years Repair: once every 12 months

Implants Replacement: once every 5 fiscal years Repair: once every 12 months

Bridges and Dentures Initial placement to replace one or more natural teeth, which are lost while covered by the plan

Dentures and bridgework replacement: one every 5 fiscal years

Replacement of an existing temporary full denture if the temporary denture cannot be repaired and the permanent denture is installed within 12 months after the temporary denture was installed

Bridges and Dentures Initial placement to replace one or more natural teeth, which are lost while covered by the plan

Dentures and bridgework replacement: one every 5 fiscal years

Replacement of an existing temporary full denture if the temporary denture cannot be repaired and the permanent denture is installed within 12 months after the temporary denture was installed

Crowns, Inlays and Onlays Replacement once every 5 fiscal years Crowns, Inlays and Onlays Replacement once every 5 fiscal years

Type D – Orthodontia How Many/How Often Type D – Orthodontia How Many/How Often

Not Covered

You, your spouse and your children, up to age 26, are covered while Dental insurance is in effect

All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia

Payments are on a repetitive basis 20% of the Orthodontia Lifetime Maximum will be

considered at initial placement of the appliance and paid based on the plan benefit’s coinsurance level for Orthodontia as defined in the plan summary

Orthodontic benefits end at cancellation of coverage The service categories and plan limitations shown above represent an overview of your Plan Benefits. This document presents the majority of services within each category, but is not a complete description of the Plan.

F r e q u e n t l y A s k e d Q u e s t i o n s Who is a participating dentist? A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for covered services provided to plan members. Negotiated fees typically range from 15%-45% below the average fees charged in a dentist’s community for the same or substantially similar services.* *Based on internal analysis by MetLife. Negotiated Fees refer to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any co-payments, deductibles, cost sharing and benefits maximums. Negotiated fees are subject to change. How do I find a participating dentist? There are thousands of general dentists and specialists to choose from nationwide --so you are sure to find one that meets your needs. You can receive a list of these participating dentists online at www.metlife.com/mybenefits or call 1-800-942-0854 to have a list faxed or mailed to you. What services are covered under this plan? All services defined under the group dental benefits plan are covered. Please review the enclosed plan benefits to learn more. May I choose a non-participating dentist? Yes. You are always free to select the dentist of your choice. However, if you choose a non-participating dentist, your out-of-pocket costs may be higher. He/she hasn’t agreed to accept negotiated fees. So you may be responsible for any difference in cost between the dentist's fee and your plan's benefit payment. Can my dentist apply for participation in the network? Yes. If your current dentist does not participate in the network and you would like to encourage him/her to apply, ask your dentist to visit www.metdental.com, or call 1-866-PDP-NTWK for an application.* The website and phone number are for use by dental professionals only. *Due to contractual requirements, MetLife is prevented from soliciting certain providers. How are claims processed? Dentists may submit your claims for you which means you have little or no paperwork. You can track your claims online and even receive email alerts when a claim has been processed. If you need a claim form, visit www.metlife.com/mybenefits or request one by calling 1-800-942-0854. Can I find out what my out-of-pocket expenses will be before receiving a service? Yes. You can ask for a pretreatment estimate. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. The estimate helps you prepare for the cost of dental services. We recommend that you request a pre-treatment estimate for services in excess of $300. Simply have your dentist submit a request online at www.metdental.com or call 1-877-MET-DDS9. You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. Can MetLife help me find a dentist outside of the U.S. if I am traveling? Yes. Through international dental travel assistance services* you can obtain a referral to a local dentist by calling +1-312-356-5970 (collect) when outside the U.S. to receive immediate care until you can see your dentist. Coverage will be considered under your out-of-network benefits.** Please remember to hold on to all receipts to submit a dental claim. *Travel Assistance services are administered by AXA Assistance USA, Inc. Certain benefits provided under the Travel Assistance program are underwritten by Virginia Surety Company, Inc. AXA Assistance and Virginia Surety are not affiliated with MetLife, and the services and benefits they provide are separate and apart from the insurance provided by MetLife. **Refer to your dental benefits plan summary for your out-of-network dental coverage. How does MetLife coordinate benefits with other insurance plans? Coordination of benefits provisions in dental benefits plans are a set of rules that are followed when a patient is covered by more than one dental benefits plan. These rules determine the order in which the plans will pay benefits. If the MetLife dental benefit plan is primary, MetLife will pay the full amount of benefits that would normally be available under the plan, subject to applicable law. If the MetLife dental benefit plan is secondary, most coordination of benefits provisions require MetLife to determine benefits after benefits have been determined under the primary plan. The amount of benefits payable by MetLife may be reduced due to the benefits paid under the primary plan, subject to applicable law. Do I need an ID card? No. You do not need to present an ID card to confirm that you are eligible. You should notify your dentist that you are enrolled in the MetLife Preferred Dentist Program. Your dentist can easily verify information about your coverage through a toll-free automated Computer Voice Response system.

E x c l u s i o n s

This plan does not cover the following services, treatments and supplies:

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;

Services for which you would not be required to pay in the absence of Dental Insurance; Services or supplies received by you or your Dependent before the Dental Insurance starts for that person; Services which are primarily cosmetic (for Texas residents, see notice page section in Certificate); 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: o Scaling and polishing of teeth; or o Fluoride treatments;

Services or appliances which restore or alter occlusion or vertical dimension; Restoration of tooth structure damaged by attrition, abrasion or erosion; Restorations or appliances used for the purpose of periodontal splinting; Counseling or instruction about oral hygiene, plaque control, nutrition and tobacco; Personal supplies or devices including, but not limited to: water picks, toothbrushes, or dental floss; Decoration, personalization or inscription of any tooth, device, appliance, crown or other dental work; Missed appointments; Services:

o Covered under any workers’ compensation or occupational disease law; o Covered under any employer liability law; o For which the employer of the person receiving such services is not required to pay; or o Received at a facility maintained by the Employer, labor union, mutual benefit association, or VA hospital;

Services covered under other coverage provided by the Employer; Temporary or provisional restorations; Temporary or provisional appliances; Prescription drugs; Services for which the submitted documentation indicates a poor prognosis; The following when charged by the Dentist on a separate basis:

o Claim form completion; o Infection control such as gloves, masks, and sterilization of supplies; or o Local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide.

Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food;

Caries susceptibility tests; Initial installation of a fixed and permanent Denture to replace one or more natural teeth which were missing before such person

was insured for Dental Insurance, except for congenitally missing natural teeth; Other fixed Denture prosthetic services not described elsewhere in the certificate; Precision attachments, except when the precision attachment is related to implant prosthetics; Initial installation of a full or removable Denture to replace one or more natural teeth which were missing before such person was

insured for Dental Insurance, except for congenitally missing natural teeth; Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person was

insured for Dental Insurance, except for congenitally missing natural teeth; Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it; Implants supported prosthetics to replace one or more natural teeth which were missing before such person was insured for

Dental Insurance, except for congenitally missing natural teeth; Fixed and removable appliances for correction of harmful habits; Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards; Diagnosis and treatment of temporomandibular joint (TMJ) disorders; Repair or replacement of an orthodontic device; Duplicate prosthetic devices or appliances; Replacement of a lost or stolen appliance, Cast Restoration, or Denture; Intra and extraoral photographic images; and Orthodontia for Base Plan only.

Alternate Benefits: Where two or more professionally acceptable dental treatments for a dental condition exist, reimbursement is based on the least costly treatment alternative. If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. To avoid any misunderstandings, we suggest you discuss treatment options with your dentist before services are rendered, and obtain a pre-treatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. You and your dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plan’s reimbursement for those services, and your out-of-pocket expense. Procedure charge schedules are subject to change each plan year. You can obtain an updated procedure charge schedule for your area via fax by calling 1-800-942-0854 and using the MetLife Dental Automated Information Service. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. Cancellation/Termination of Benefits: Coverage is provided under a group insurance policy (Policy form GPNP99) issued by MetLife. Coverage terminates when your membership ceases, when your dental contributions cease or upon termination of the group policy by the Policyholder or MetLife. The group policy terminates for non-payment of premium and may terminate if participation requirements are not met or if the Policyholder fails to perform any obligations under the policy. The following services that are in progress while coverage is in effect will be paid after the coverage ends, if the applicable installment or the treatment is finished within 31 days after individual termination of coverage: Completion of a prosthetic device, crown or root canal therapy. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details. L0316460047[exp0417][All States][DC,GU,MP,PR,VI] ©2016 Metropolitan Life Insurance Company, New York, NY 10166

We’re Here to Help

With MetLife, you and your family get much more than dental coverage. You get support and educational tools to help you achieve your oral health goals. Now that’s something to smile about.

We’re at your service. With MyBenefits, managing your dental plan couldn’t be easier. The secure member website lets you take charge. You can:

Review your dental policy information.

View a list of your covered dependents and their coverage descriptions.

Find a participating dentist.

Check the status of your claims.

Visit the oral health library to view educational articles and tools.

As a first time user, simply go to www.metlife.com/mybenefits and follow the easy registration instructions. Find a network dentist. With thousands of general dentists and specialists to choose from nationwide, you are sure to find one who meets your needs. Just log in to www.metlife.com/mybenefits and follow these steps:

Click on “Find a Dentist”

Enter your city, state or ZIP code. If your current dentist does not participate in the network, you can encourage him or her to apply. Ask your dentist to visit www.metdental.com or call 1-877-MET-DDS9 for an application.1 Tips for easy dental claim filing. Filing a dental claim is simple — just follow these tips:

Bring a claim form with you to your appointment.

You can get additional claim forms three easy ways:

1. Online at www.metlife.com/mybenefits or www.metlife.com/dental,

2. Call 1-800-942-0854 to have a form sent to you, or

3. Contact your Human Resources representative.

Also, speak with your dentist about reimbursement arrangements before your appointment. Although most dentists will accept the claim reimbursement directly from MetLife, some may prefer to receive payment in-full before you leave your appointment. Since each dentist sets his or her own policy, you should discuss these arrangements before you receive any services.

We’re Here to Help (continued)

International Dental Travel Assistance This dental benefits plan includes international dental travel services which offer you and your covered dependents referrals for immediate dental care while traveling internationally.2 These services are available 24/7 and give you access to international dental providers in more than 200 countries. With just one phone call, you will reach a multilingual assistance coordinator who will help you get the care you need. Coverage will be considered under your out-of-network benefits.3 Be sure to hold on to all receipts to submit a dental claim. Claim forms are available online at www.metlife.com/mybenefits or www.metlife.com/dental. Help on the Go! If you’re on the go and need to find an in-network provider, view a claim or see your ID card, there’s an app for that. With the MetLife Dental Mobile App4, you can:

Find a dentist.

View your claims.

View your ID card. It’s easy. Search “MetLife” at the iTunes App Store or Google Play to download the app. Then use your MyBenefits log-in information to access this feature.5 1 Due to contractual requirements, MetLife is prevented from soliciting certain providers. 2 Travel assistance services are administered by AXA Assistance USA, Inc. AXA Assistance is not affiliated with MetLife, and the

services they provide are separate and apart from the benefits provided by MetLife. Referral services are not available in all locations.

3 Refer to your dental benefits plan summary for your out-of-network dental coverage. 4 The features of the MetLife Dental Mobile App are not available for all MetLife Dental Plans. 5 Before using the MetLife Dental Mobile App, you must register at www.metlife.com/mybenefits from a computer. Registration

cannot be done from your mobile device.

Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods, and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details. L0415417223[exp0616][All States][DC,GU,MP,PR,VI] Metropolitan Life Insurance Company, New York, NY 10166

MetLife VisionProduct Overview

Vision insurance for healthy savings.

With MetLife Vision, you could enjoy discounts on vision wear and services. You also get support to live healthier. Through an exam, eye doctors are often the first to detect signs of serious health problems.1

It’s simple.

You save on exams, glasses, contact lenses, laser vision correction and more.2

There are no out-of-pocket costs on polycarbonate (shatter-resistant) lenses for children up to age 18 or for ultraviolet (UV) coating.Take advantage of fixed copays for scratch-resistantand anti-reflective coatings, progressive lenses and more.The plan is easy to use. When you go to a participating vision specialist there are no claims to file. You don’t even need an ID card.

A big network means more options.You can go to any licensed vision care specialist or choose from a large network of ophthalmologists, optometrists and opticians at private practices or retail locations like Costco® Optical, America’s Best, Cohen’s Fashion Optical, Eyeglass World, For Eyes Optical, Pearle Vision,3 Shopko, Visionworks and more.For additional convenience, a special service arrangement with WalMart and Sam’s Club makes it easy for you to use your benefits even though they are out of network.

Why vision insurance makes senseStay well. Stay healthy. Save more.

Get the style you want.

Choose from classic styles to the latest designer frames — and select what’s right for you and your budget.Some of the great brands to choose from include Anne Klein, bebe®, Calvin Klein, Flexon, Lacoste, Nike, Nine West and more.

Sample Savings:

1 Why Are Eye Exams Important? http://www.allaboutvision.com/eye-exam/importance.htm, Accessed April 2016.2 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 innetwork contracted facilities.3 Not all Pearle Vision locations participate in the MetLife Vision program. Please visit www.metlife.com/vision to confirm participating locations by using our Find A Provider online directory.4 Comparison is based on national averages and most commonly purchased brands.5 These are sample savings only. Your actual savings by enrolling in the MetLife Vision Plan will depend on various factors, including plan premiums, number of visits by your family per year and the cost of services rendered. Be sure to review the enclosed Schedule of Benefits for your plan’s specific benefits and other important details.6 Based on employee-only rate for M130-10/25 standard plan design with employees nationwide.

Benefits are underwritten by Metropolitan Life Insurance Company, New York, NY (MetLife). Certain claims and network administration services are provided through Vision Service Plan (VSP). VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. In certain states, availability of MetLife’s group vision benefits is subject to regulatory approval. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details.

Metropolitan Life Insurance Company200 Park Avenue, New York, NY 10166© 2016 METLIFE, INC.L0416464321[exp0417][All States][DC,GU,MP,PR,VI]

Now that you know how Vision Insurance can help you save, take a few minutes to enroll today!

Understanding Your Vision Benefits

With MetLife Vision you get benefits for a wide range of covered services. The plan is simple and convenient to use— and you can take advantage of great savings and offers on the latest eyewear styles and brand names. Value and savings: Your out-of-pocket costs are usually lower when you visit a participating vision care specialist. And you can typically save even more when you go to a participating private practice.

Vision Services1 Your cost without coverage

Your cost with MetLife Vision You Save2

Eye exam $140 $10 (copay) $130

Glasses N/A $25 (copay) NA

Frame $140 $8 $132

Lenses (Bifocal) $139 $0 $139

UV Coating $23 $0 $23

Anti-Reflective Coating

$106 $69 $37

Annual Premium3 NA $84 NA

Total Cost of Services $548 $196 $461

Convenience and choice of eye care professionals: You can go to any licensed eye care professional. Or you can choose from any of the thousands of participating ophthalmologists, optometrists and opticians working out of private practices or top retail chains, like Costco® Optical, America’s Best, Cohen’s Fashion Optical, Eyeglass World, Pearle Vision, Shopko and Visionworks. You can also take advantage of our service arrangement with Walmart and Sam’s Club. They check your eligibility and process claims even though they are out-of-network. Enhanced benefits:4 As a commitment to your overall vision care, you get full coverage for ultraviolet protection and polycarbonate (shatter resistant) lenses for children up to age 18. You also save on popular lens enhancements like progressive or scratch resistant lenses -- we have negotiated maximum copays with participating locations, so they can’t charge you above a certain amount.

Understanding Your Vision Benefits (continued)

Your plan also offers the following enhanced benefit(s): Second pair: You have an additional eyewear benefit that gives your coverage for two pairs of glasses or glasses and contacts.

Covered contact lenses: Enjoy full coverage for contact lenses, including fitting and evaluation services, in addition to your standard eyewear benefit.

Safety eye care: Offers coverage for a supplemental safety eye exam and eyewear—so you get extra support to help protect your vision. The benefit is only available to you and does not cover your dependents.* Computer vision care: Covers exams specifically designed to detect eye health and vision issues caused by regular computer and digital device use. It also provides additional coverage for prescription eyewear specifically for computer use.* Diabetic Eyecare Plus program: Delivers additional support, including supplemental exams and tests, if you have type 1 or type 2 diabetes and have specific ophthalmological conditions.* Vision therapy: You get benefits to support certain vision disorders. If you qualify, you will get a treatment plan intended to correct or improve dysfunctions like, but not limited to lazy eye, eye focusing, and general eye movement ability.*

Low vision: Provides additional benefits to those who are not legally blind, but whose eyesight cannot be corrected to 20/70 with the use of optical lenses. They include supplemental vision testing and aids.* *You must go to a participating private practice to receive in-network benefits. Services provided at a participating retailer will be considered out-of-network. Great eyewear selections:5 You can choose the eyewear that is right for you and your budget. Plus, all participating locations offer a large selection of eyewear. From classic styles to the latest designer frames, you will find hundreds of options for you and your family. Choose from great brands, like Ann Klein, bebe®, Calvin Klein, Flexon, Lacoste, Nike, Nine West and more.

Understanding Your Vision Benefits (continued)

The information below explains certain terms and information to make it easier for you to understand and use your benefits. 1. In-Network: When you visit vision care specialists participating in the MetLife Vision plan, either through a private practice or retail chain location. Copay: Refers to the amount in the Schedule of Benefits for covered services that you are required to pay your participating vision care specialist at the time of treatment. 2. Frequency: How often you can get an exam or eyewear. 3. Eye Exam: Comprehensive examination of visual functions and prescription of corrective eyewear if necessary. Including but not limited to:

Eye Health Examination; Dilation; and Refraction and Prescription for Glasses

4. Frame Allowance: The amount MetLife provides toward the cost of your frame. 5. Standard Corrective Lenses: Standard lenses that are covered under the plan.

Single Vision: Types of lenses that correct one vision problem, like near or far-sightedness.

Lined Bifocal: Types of lenses that use two different distinct powers in each lens, usually for near and distance vision correction.

Lined Trifocal: Types of lenses that have three regions to correct for distance, intermediate (arm's length), and near vision.

Lenticular: Types of lenses that have an array of magnifying lenses, designed so that when viewed from slightly different angles, different images are magnified.

6. Standard Lens Enhancements4: Lens enhancements improve the appearance, durability and/or function of your glasses.

Ultraviolet Coating: A treatment that is applied to lenses to filter out harmful rays of the sun. It is recommended that glasses block 100% of both UVA and UVB rays to minimize eye damage from the sun’s rays.

Polycarbonate Lenses: A lens material that is thinner, lighter, and more impact resistant than standard plastic. Polycarbonate lenses are the standard for children’s eyewear.

Standard Progressive: Bi-focal or multi-focal lenses with no visible lines where the lens power gradually changes from distance to near.

Scratch-Resistant Coating: A film or coating that protects lenses from scratching.

Understanding Your Vision Benefits (continued)

Standard Anti-Reflective Coating: A lens treatment for your glasses that helps to

reduce distracting glare and eye fatigue by reducing the amount of light reflecting off the lens surface and making the lenses appear clearer. Your eyes will also be more visible behind the lenses.

Photochromic: Refers to lenses that automatically change from clear to dark in the presence of ultraviolet (UV) radiation.

7. Contact Lenses

Fitting and Evaluation: The goal of a contact lens fitting is to find the most appropriate contact lens for optimal comfort and vision. Contacts come in a variety of types, styles, materials and sizes.

Fitting Fee: The charge associated with the contact lens fitting. This fee is separate from the standard Eye Exam. The contact lens fitting fee is charged for:

o The initial assessment of the power, diameter, material, and base curve (essentially parameters) of the lens best fitted for the patient.

o Follow up exams necessary to ensure that the contact lenses are the right fit and prescription.

o Final prescription for dispensing. Elective Lenses: If available on your plan, you may choose to wear contact lenses in

lieu of glasses as your vision correction. Necessary: Necessary Contact Lenses are a Plan Benefit when specific benefit criteria

are satisfied and when prescribed by the Covered Person’s participating vision care specialist. Contact Lenses are provided in place of spectacle lens and frame benefits available.

8. Out-Of-Network: When you visit an out-of-network vision care specialist, you are responsible for the services provided. You will typically pay for the full cost of the treatment at the time of the visit, then submit a claim form for reimbursement from MetLife. Allowance: The amount MetLife provides toward the cost of your eye examination or eyewear. 1 Comparison is based on national averages and most commonly purchased brands. 2 Your actual savings by enrolling in the MetLife Vision Plan will depend on various factors, including plan premiums, number of visits by your family per year and the cost of services rendered. Be sure to review the enclosed Schedule of Benefits for your plan’s specific benefits and other important details. 3 Based on employee-only rate for M130-10/25 standard plan design with employees nationwide. 4 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 to confirm the availability of lens enhancements and pricing prior to receiving services. Additional discounts may not be available in certain states. 5 Some brands of spectacle frames may be unavailable for purchase as Plan Benefits, or may be subject to additional limitations. Benefits are underwritten by Metropolitan Life Insurance Company, New York, NY. Certain claim and network administration services are provided through Vision Service Plan (VSP). VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. In certain states, availability of MetLife’s group vision benefits is subject to regulatory approval. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods, and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details. L1015441081[exp1116][All States][DC,GU,MP,PR,VI] Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166

With your Vision Preferred Provider Organization Plan, you can: Go to any licensed vision

specialist and receive coverage. Just remember your benefit dollars go further when you stay in-network.

Choose from a large network of

ophthalmologists, optometrists and opticians, from private practices to retailers like Costco® Optical and Visionworks.

Take advantage of our service

agreement with Walmart and Sam's Club—they check your eligibility and process claims even though they are out-of-network.

In-network value added features:

Additional lens enhancements:1

Average 20-25% savings on all other lens enhancements. Savings on glasses and sunglasses: Get 20% savings on additional pairs of prescription glasses and non-prescription sunglasses, including lens enhancements. At times, other promotional offers may also be available. Laser vision correction: 2 Savings averaging 15% off the regular price or 5% off a promotional offer for laser surgery including PRK, LASIK and Custom LASIK. This offer is only available at MetLife participating locations.

We’re here to help

Find a Vision provider at www.metlife.com/vision Download a claim form at www.metlife.com/mybenefits For general questions go to www.metlife.com/mybenefits or call 1-855-MET-EYE1 (1-855-638-3931)

In-network benefits There are no claims for you to file when you go to an in-network vision specialist. Simply pay your copay and, if applicable, any amount over your allowance at the time of service.

Frequency

Eye exam Once every 12 months

Eye health exam, dilation, prescription and refraction for glasses: Covered in full after a $10 copay.

Retinal imaging:1 Up to a $39 copay on routine retinal screening when performed by a private practice.

Frame Once every 12 months

Allowance: $150

Costco: $70 allowance

You will receive an additional 20% savings on the amount that you pay over your allowance. This offer is available from all participating locations except Costco.1

Standard corrective lenses Once every 12 months

Single vision, lined bifocal, lined trifocal, lenticular: Covered in full after $15 eyewear copay.

Standard lens enhancements1 Once every 12 months

Polycarbonate (child up to age 18), and Ultraviolet (UV) coating: Covered in full.

Progressive, Polycarbonate (adult), Photochromic, Anti-reflective and Scratch-resistant coatings and Tints: Your cost will be limited to a copay that MetLife has negotiated for you. These copays can be viewed after enrollment at www.metlife.com/mybenefits.

Contact lenses Once every 12 months

Contact fitting and evaluation:1 Covered in full with a maximum copay of $60.

Elective lenses: $150 allowance.

Necessary lenses: Covered in full after $15 eyewear copay.

Low vision Once every 24 months Provides additional benefits to members who are not legally blind, but whose eyesight cannot be corrected to 20/70 with the use of optical lenses. Not available at retail chains including Costco.

Supplemental testing: Maximum of two (2) tests covered in full within a two (2) year period up to the benefit maximum.

Supplemental aids: 75% of the allowable amount up to the benefit maximum every two (2) years.

Benefit maximum: $1,000 every two (2) years.

Empire Southwest, LLC. Vision Benefits Overview Summary of the benefits provided under this plan.

Exclusions and Limitations of Benefits This plan does not cover the following services, materials and treatments SERVICES AND EYEWEAR

• Services and/or materials not specifically included in the Vision Plan Benefits Overview (Schedule of Benefits).

• Any portion of a charge above the Maximum Benefit Allowance or reimbursement indicated in the Schedule of Benefits.

• Any eye examination or corrective eyewear required as a condition of employment.

• Services and supplies received by you or your dependent before the Vision Insurance starts.

• Missed appointments.

• 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 Worker’s Compensation Law, Employer’s Liability Law or similar law. You must promptly claim and notify the Company of all such benefits.

• Local, state, and/or federal taxes, except where MetLife is required by law to pay.

• 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.

• Services and materials obtained while outside the United States, except for emergency vision care.

• Services, procedures, or materials for which a charge would not have been made in the absence of insurance.

• 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.

• Plano lenses (lenses with refractive correction of less than ± 0.50 diopter).

• Two pairs of glasses instead of bifocals.

• 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.

• Contact lens insurance policies and service agreements.

• Refitting of contact lenses after the initial (90 day) fitting period.

• Contact lens modification, polishing, and cleaning.

TREATMENTS

• Orthoptics or vision training and any associated supplemental testing.

• Medical and surgical treatment of the eye(s).

MEDICATIONS

• Prescription and non-prescription medications.

1 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 to confirm your availability of lens enhancements and pricing prior to receiving services. Additional discounts may not be available in certain states. 2 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. Additional savings on laser vision care is only available at participating locations. Important: If you or your family members are covered by more than one health care plan, you may not be able to collect benefits from both plans. Each plan may require you to follow its rules or use specific doctors and hospitals, and it may be impossible to comply with both plans at the same time. Before you enroll in this plan, read all of the rules very carefully and compare them with the rules of any other plan that covers you or your family. M130A-10/15-M MetLife Vision benefits are underwritten by Metropolitan Life Insurance Company, New York, NY. Certain claims and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. In certain states, availability of MetLife’s Group Vision benefits is subject to regulatory approval. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods, and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details. L0616468232 exp0817 All States Metropolitan Life Insurance Company, New York, NY

Out-of-network reimbursement You pay for services and then submit a claim for reimbursement. The same benefit frequencies for in-network benefits apply. Once you enroll, visit www.metlife.com/mybenefits for detailed out-of-network benefits information.

• Eye exam: up to $45 • Single vision lenses: up to $30 • Lined trifocal lenses: up to $65

• Frames: up to $70 • Lined bifocal lenses: up to $50 • Progressive lenses: up to $50

• Contact lenses: • Lenticular lenses: up to $100 - Elective up to $105 - Necessary up to $210

Frequently Asked Questions

How do I use my benefits? Whether you choose to see an in-network provider or not, using your vision coverage is simple and convenient.

• Select Find a Vision Provider at www.metlife.com/vision to find an eye care provider who is right for you.

• Review your plan coverage before your appointment.

• At your appointment, tell them you have MetLife Vision. No ID card is necessary. There are no claim forms to complete when you see an in-network provider. If you visit an out-of-network provider, you will pay the provider in full for the services and eyewear received at the time of your appointment, including taxes. Then submit a completed MetLife Vision claim form and itemized receipt to: MetLife Vision Claims, PO Box 385018, Birmingham, AL 35238-5018. Do I have to visit a participating vision care specialist to get coverage? No. You can visit any provider. However, your out-of-pocket costs are usually lower when you visit an in-network provider, and you have the opportunity to save even more. Do my dependents have to visit the same doctor that I select? No. You and your dependents each have the freedom to choose any provider. Do I need to file a claim? Not if you visit a network provider or visit a Walmart or Sam’s Club location. If you stay in-network for care, the network provider will confirm your eligibility, submit the claim and calculate your out-of-pocket costs, if any, at the time of service. Additionally, MetLife has an agreement with Walmart that Walmart and Sam’s Club locations will accept MetLife Vision plan, verify eligibility and submit claims. If you visit an out-of-network provider, other than Walmart or Sam’s Club, you pay the provider in full for the services and eyewear received at the time of your appointment, including taxes. Then you submit a completed MetLife Vision claim form and itemized receipt to: MetLife Vision Claims, PO Box 385018, Birmingham, AL 35238-5018. Claim forms are available at www.metlife.com/mybenefits or call Customer Service 1-855-MET-EYE1 (1-855-638-3931). How do I locate a vision care specialist? With this plan, you have access to thousands of private practice optometrists, ophthalmologists and opticians – credentialed according to National Committee of Quality Assurance (NCQA) standards – as well as top retail optical providers, like Costco Optical, Visionworks, and more. You have the convenience to choose based upon your needs and preferences at the time of service. To locate a MetLife Vision network provider 24 hours a day, seven days a week, select Find a Vision Provider at www.metlife.com/vision or call MetLife Vision at 1-855-MET-EYE1 (1-855-638-3931) for access to our 24/7 Interactive Voice Response system. How can I check if a claim has been processed? If you used your benefits at an in-network provider, you do not need to check the status of a claim, as we will work with your provider directly. If you filed an out-of-network claim, simply visit www.metlife.com/mybenefits, our secure member website, to check your claim history.

Frequently Asked Questions (continued)

Do I need an ID card in order to use my benefit or discount? No. You do not need an ID card in order to get services through your vision plan. I've used up my benefit, but would like to get another pair of eyeglasses. Are there any additional savings available? Yes. Your vision plan includes discounts on additional services from participating private practice providers, including 20% off complete pairs of prescription eyeglasses and sunglasses. Go to www.metlife.com/mybenefits to view the full details of the additional discounts available. Do I have to choose from a select set of eyewear or can I choose any eyewear and apply my benefits? You can choose the eyewear that is right for you and your budget. All network private practice and retail locations offer a broad spectrum of eyewear options. From classic styles to the latest designer frames, you will find hundreds of options for you and your family. Are contact lenses covered under this plan? Yes. Either contact lenses or glasses are allowed within the benefit frequency defined in your Schedule of Benefits. Can I order my contact lenses through the mail? MetLife does not have an in-network mail order program. If you purchase contact lenses through the mail it will be out-of-network and you will need to submit your claim and receipts to MetLife for your out-of-network reimbursement. Is laser vision correction covered under this plan? MetLife Vision’s Laser VisionCare Program provides members with discounts through contracted laser facilities. Discounts average 15% off or 5% off a promotional offer for laser vision surgery, including PRK, LASIK and Custom LASIK*. *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. Additional savings on laser vision care is only available at participating locations. Can I get an eye examination from one provider and my glasses or contact lenses from another? Yes. Your MetLife Vision benefits allow you to get an eye examination from one provider and your glasses or contact lenses from another. You will need to check with your provider to see what your policy is for filling another doctor’s prescription. However, please note, under this plan, only one lens benefit (either glasses or contact lenses) is allowed per frequency. Can I apply FSA funds to out-of-pocket costs after my vision benefit is applied? Yes. You can use your Flexible Spending Account (FSA) to pay for a variety of health-related out-of-pocket expenses, including those associated with ancillary benefits like this plan. Money from the FSA can be applied toward the eye exam copay, out-of-pocket costs for prescription glasses or contact lenses (including upgrades) and supplies such as contact lens solution. Employees can even use FSA funds for LASIK surgery. Benefits are underwritten by Metropolitan Life Insurance Company, New York, NY. Certain claim and network administration services are provided through Vision Service Plan (VSP). VSP is not affiliated with Metropolitan Life Insurance Company or its affiliates. In certain states, availability of MetLife’s group vision benefits is subject to regulatory approval. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods, and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details. L1015441999[exp1116][All States][DC,GU,MP,PR,VI] Metropolitan Life Insurance Company, 200 Park Avenue, New York, NY 10166

Like most insurance policies, insurance policies offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions, limitations, and terms for keeping them in force. Please contact MetLife or your plan administrator for complete details.

Certain of the benefits mentioned in this communication may be sponsored by your employer as part of an employee benefit plan subject to the Employee Retirement Income Security Act of 1974, as amended (“ERISA”). Those policies/products which are not part of an employer-sponsored plan are offered by MetLife or an affiliate and are not subject to ERISA. With respect to employer-sponsored benefits, you should obtain additional information regarding terms and eligibility from your employer. The MetLife Auto & Home® Group Insurance Program is not part of your employer-sponsored plan and is not subject to ERISA.

The companies listed in this communication operate independently and are not responsible for each other’s financial obligations.

Required Regulatory Information

CPN–Group–Initial Enr/SOH-2015 1

Our Privacy Notice We know that you buy our products and services because you trust us. This notice explains how we protect your privacy and treat your personal information. It applies to current and former customers. “Personal information” as used here means anything we know about you personally.

Plan Sponsors and Group Insurance Contract Holders

This privacy notice is for individuals who apply for or obtain our products and services under an employee benefit plan, or group insurance or annuity contract. In this notice, “you” refers to these individuals.

Protecting Your Information

We take important steps to protect your personal information. We treat it as confidential. We tell our employees to take care in handling it. We limit access to those who need it to perform their jobs. Our outside service providers must also protect it, and use it only to meet our business needs. We also take steps to protect our systems from unauthorized access. We comply with all laws that apply to us.

Collecting Your Information

We typically collect your name, address, age, and other relevant information. We may also collect information about any business you have with us, our affiliates, or other companies. Our affiliates include life, car, and home insurers. They alsoinclude a bank, a legal plans company, and securities broker-dealers. In the future, we may also have affiliates in other businesses.

How We Get Your Information

We get your personal information mostly from you. We may also use outside sources to help ensure our records are correct and complete. These sources may include consumer reporting agencies, employers, other financial institutions, adult relatives, and others. These sources may give us reports or share what they know with others. We don’t control the accuracy of information outside sources give us. If you want to make any changes to information we receive from others about you, you must contact those sources.

We may ask for medical information. The Authorization that you sign when you request insurance permits these sources to tell us about you. We may also, at our expense:

Ask for a medical exam Ask for blood and urine tests Ask health care providers to give us health data, including information about alcohol or drug abuse

We may also ask a consumer reporting agency for a “consumer report” about you (or anyone else to be insured). Consumer reports may tell us about a lot of things, including information about:

Reputation Driving record Finances Work and work history Hobbies and dangerous activities

The information may be kept by the consumer reporting agency and later given to others as permitted by law. The agency will give you a copy of the report it provides to us, if you ask the agency and can provide adequate identification. Ifyou write to us and we have asked for a consumer report about you, we will tell you so and give you the name, address and phone number of the consumer reporting agency.

Another source of information is MIB Group, Inc. (“MIB”). It is a non-profit association of life insurance companies. We and our reinsurers may give MIB health or other information about you. If you apply for life or health coverage from another member of MIB, or claim benefits from another member company, MIB will give that company any information that it has about you. If you contact MIB, it will tell you what it knows about you. You have the right to ask MIB to correct its information about you. You may do so by writing to MIB, Inc., 50 Braintree Hill, Suite 400, Braintree, MA 02184-8734, by calling MIB at (866) 692-6901 (TTY (866) 346-3642 for the hearing impaired), or by contacting MIB at www.mib.com.

Using Your Information

We collect your personal information to help us decide if you’re eligible for our products or services. We may also need it toverify identities to help deter fraud, money laundering, or other crimes. How we use this information depends on what products and services you have or want from us. It also depends on what laws apply to those products and services. For example, we may also use your information to:

CPN–Group–Initial Enr/SOH-2015 2

administer your products and services process claims and other transactions perform business research confirm or correct your information market new products to you help us run our business comply with applicable laws

Sharing Your Information With Others

We may share your personal information with others with your consent, by agreement, or as permitted or required by law. We may share your personal information without your consent if permitted or required by law. For example, we may share your information with businesses hired to carry out services for us. We may also share it with our affiliated or unaffiliated business partners through joint marketing agreements. In those situations, we share your information to jointly offer you products and services or have others offer you products and services we endorse or sponsor. Before sharing your information with any affiliate or joint marketing partner for their own marketing purposes, however, we will first notify you andgive you an opportunity to opt out. Other reasons we may share your information include:

doing what a court, law enforcement, or government agency requires us to do (for example, complying with search warrants or subpoenas)

telling another company what we know about you if we are selling or merging any part of our business giving information to a governmental agency so it can decide if you are eligible for public benefits giving your information to someone with a legal interest in your assets (for example, a creditor with a lien on

your account) giving your information to your health care provider having a peer review organization evaluate your information, if you have health coverage with us those listed in our “Using Your Information” section above HIPAA

We will not share your health information with any other company – even one of our affiliates – for their own marketing purposes. The Health Insurance Portability and Accountability Act (“HIPAA”) protects your information if you request or purchase dental, vision, long-term care and/or medical insurance from us. HIPAA limits our ability to use and disclose the information that we obtain as a result of your request or purchase of insurance. Information about your rights under HIPAA will be provided to you with any dental, vision, long-term care or medical coverage issued to you. You may obtain a copy of our HIPAA Privacy Notice by visiting our website at www.MetLife.com. For additional information about your rights under HIPAA; or to have a HIPAA Privacy Notice mailed to you, contact us at HIPAAprivacyAmericasUS@metlife.com, or call us at telephone number (212) 578-0299.

Accessing and Correcting Your Information

You may ask us for a copy of the personal information we have about you. Generally, we will provide it as long as it is reasonably retrievable and within our control. You must make your request in writing listing the account or policy numbers with the information you want to access. For legal reasons, we may not show you privileged information relating to a claim or lawsuit, unless required by law.

If you tell us that what we know about you is incorrect, we will review it. If we agree, we will update our records. Otherwise,you may dispute our findings in writing, and we will include your statement whenever we give your disputed information to anyone outside MetLife.

Questions

We want you to understand how we protect your privacy. If you have any questions or want more information about this notice, please contact us. When you write, include your name, address, and policy or account number.

Send privacy questions to:MetLife Privacy Office P. O. Box 489 Warwick, RI 02887-9954 privacy@metlife.com

We may revise this privacy notice. If we make any material changes, we will notify you as required by law. We provide this privacy notice to you on behalf of these MetLife companies: Metropolitan Life Insurance Company MetLife Health Plans, Inc. MetLife Insurance Company USA General American Life Insurance Company SafeGuard Health Plans, Inc. SafeHealth Life Insurance Company

CA LAP STANDALONE NOTICE (09/08)

CALIFORNIA HEALTHCARE LANGUAGE ASSISTANCE PROGRAM NOTICE TO INSUREDS No Cost Language Services. You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card, if any, or 1-800-942-0854. For more help call the CA Dept. of Insurance at 1-800-927-4357. To receive a copy of the attached MetLife document translated into Spanish or Chinese, please mark the box by the requested language statement below, and mail the document with this form to: Metropolitan Life Insurance Company PO Box 14587 Lexington, KY 40512 Please indicate to whom and where the translated document is to be sent.

Servicio de Idiomas Sin Costo. Puede obtener la ayuda de un intérprete. Se le pueden leer documentos y enviar algunos en español. Para recibir ayuda, llámenos al número que aparece en su tarjeta de identificación, si tiene una, o al 1-800-942-0854. Para recibir ayuda adicional llame al Departamento de Seguros de California al 1-800-927-4357. Para recibir una copia del documento adjunto de MetLife traducido al español, marque la casilla correspondiente a esta oración, y envíe por correo el documento junto con este formulario a: Metropolitan Life Insurance Company PO Box 14587 Lexington, KY 40512 Por favor, indique a quién y a dónde debe enviarse el documento traducido. NOMBRE DIRECCIÓN

ID 1-800-942-0854 1-800-927-4357MetLife

Metropolitan Life Insurance Company PO Box 14587 Lexington, KY 40512

0010

3115

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Below are your benefit ID cards.You are not required to show your card as proof of coverage,but we'veprovided them for your convenience.You can also view your ID card on the MetLife mobile app.1 Search"MetLife" at iTunes App Store or Google Play to download the app.2

1 800 GET-MET 8 (1-800-438-6388)

www.metlife.com/mybenefits

1-800-GET-MET8

www.metlife.com/mybenefits

PDP PLUS NETWORK

Employee Name

Empire Southwest LLC

Employee ID

142815

Employee ID

142815Empire Southwest LLC

Employee Name

FRONT BACK

1900032619 (0616)© 2016 METLIFE, INC. L0616468856[exp0817][All States]PEANUTS © 2016 Peanuts Worldwide

Metropolitan Life Insurance Company200 Park AvenueNew York, NY 10166www.metlife.com

BENEFITS’35(/ "31%)/ /3*2!) /$) *#6)/3 -),#)& 83.1+)5)4/07

OVERVIEW

1900032619 (0616)© 2016 METLIFE, INC. L0616468856[exp0817][All States]PEANUTS © 2016 Peanuts Worldwide