Page 43 - The Legacy School Benefit Booklet 2021-2022
P. 43
Dental Summary (Continued)
CareFirst BlueDental Plus
Benefits
Plan 5
Annual Maximum
Referral Needed No
Class I, II, III & IV $2,000
Internet Sites
Doctor Provider Site www.carefirst.com
Monthly Rates
Individual $33.39
Parent/Child $80.14
Employee/Spouse $66.78
Family $130.22
Effective Date: 02/01/2021
Changes, census corrections or geographic changes. This description of benefits is intended for summary
and comparison purposes only and based on our interpretation.
