Vision Claim Form – Preferred Benefit Administrators

Updated May 16, 2022

Updated May 16, 2022

File Description

Preferred Benefit Administrators has been selected as the new Claims Administrator for the St. Johns County School District Vision Benefit Plan, effective 1/1/2022.

There are no changes to your vision benefits for the 2022 plan year except where your vision reimbursement requests should be submitted.

How to request a vision plan reimbursement:

  • Complete a Vision Request for Reimbursement form.
  • Attach an itemized bill or payment receipt from your vision provider.  Be sure it includes the type of service received.

You have several options for submitting your vision reimbursement requests:

  • Fax your request to (407)786-2999.
  • Mail your request to the address at the bottom of this letter.

If you should have any vision claims/eligibility related questions, please feel free to contact our office for assistance at (888)524-2777:

Important Vision Plan reminders:

  • Visit any vision provider you choose; there are no vision network restrictions.
  • All Vision Plan requests for reimbursement must be submitted within six (6) months from the date of service for your vision claim to be reimbursed.
  • Your Vision Plan Document & Summary Plan Description can be viewed online by visiting our website at