Forms & publications

This benefits book describes what is covered as a SEBB member under Davis Vision by MetLife, 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.

Preauthorization requirements for Davis 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.

Use this form to name the persons or entities you want to receive your life insurance proceeds after your death. Return this form to MetLife.

MetLife life and accidental death and dismemberment insurance certificate of coverage for school employees enrolled in SEBB benefits who work at least 630 hours.

MetLife life and accidental death and dismemberment insurance certificate of coverage for school employees enrolled in SEBB benefits who work less than 630 hours.

Use this form to name the persons or entities you want to receive your life insurance proceeds after your death. Return this form to MetLife.

Use this form to cancel your MetLife retiree term life insurance coverage.

Use this form if you are a School employee and you wish to cancel your supplemental life and/or accidental death and dismemberment (AD&D) insurance.

Use this form to notify MetLife that you wish to cancel your Supplemental Life Insurance and/or Supplemental Accidental Death & Dismemberment (AD&D) Insurance. For employees only: Employee Basic Life Insurance ($35,000) and Employee Basic AD&D Insurance ($5,000) is not affected by this form. It is provided by your employer at no cost to you. You cannot cancel your Employee Supplemental Life Insurance and keep Dependent Life Insurance.

This is the MetLife PEBB retiree life insurance certificate of coverage (COC) for employees.