Page 47 - The Legacy School Benefit Booklet 2021-2022
P. 47
Vision Benefits
The Legacy School provides Vision benefits through the following plan:
CareFirst BlueVision Plus Option B
» Choose from a large national network of providers.
» In-Network and Out-of-Network coverage. (Note: If you use an out-of-network provider then you
will need to pay the full cost up-front then submit for reimbursement)
» Vision exam covered in full with a $10 copay and substantial discounts on vision correction
materials through Davis Vision.
» Please refer to the attached summary plan description for more details.
CareFirst BlueVision
Plus Option B
Benefits $10 Exam/12 Month
In Out
Coinsurance 100% Allowance
Exam $10 Copay $45 Allowance
Eye Glasses Lenses Single: 100% Single: $52 Allowance
T ower: 100%
Frame Allowance Non-Tower: $60 Allowance
$130 Allowance
Contact Lenses Elective: No copay for Elective: $112 Allowance
Davis Vision Collection
Service Interval 12 Mos. As INN
Lenses and Frame Service Interval 12/24 Mos. As INN
Monthly Rates
Individual $7
Parent/Child $13
Employee/Spouse $16
Family $20
