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Plan Highlights:
This vision plan is for members enrolled in our BlueChoice HMO Plan.
- You may use any vision care provider and any vision dealer for lens and frame purchases.
- Those providers and dealers who participate with CareFirst BlueCross BlueShield will submit your vision claims for you.
- Participating vision providers will be reimbursed with vision schedule allowances for services provided.
- All vision providers may balance bill the member for charges above the scheduled allowances.
For services provided by a non-participating provider, you will have to file the claim and be reimbursed for services. You can download a vision claim form or call the State operations center at 410-581-3601 for claim forms.
Routine Eye Exam
The plan pays up to $45 for a routine eye exam. This service is available once per year. Benefits are not included for eye refractions.
Prescription Lenses (per pair)
(Available once every year) |
|
| Single Vision |
$ |
28.80 |
| Bifocal, single |
$ |
48.60 |
| Bifocal, double |
$ |
88.20 |
| Trifocal |
$ |
70.20 |
| Aphakic, Glass |
$ |
54.00 |
| Aphakic, Plastic |
$ |
126.00 |
| Aphakic, Aspheric |
$ |
162.00 |
| Frames (Available once every year) |
$ |
45.00 |
Contacts (per pair, in lieu of frames & lenses)
(Available once every year) |
| Medically neccessary |
$ |
201.60 |
| Cosmetic |
$ |
50.40 |
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