Help and Resources


Forms and Documents

Out-of-Network Claim Form
You can access an out-of-network claim form from the Benefit Details page. Use this form to submit a vision claim from an out of network provider.

Please note: The majority of EyeMed plans provide up to one year to file claims, meaning most members must submit their claim form within one (1) year from the original date of service. To ensure your claim is filed in a timely manner, please review your employer?s plan information for any claim filing time limits.

When there is no provider available:

You have the right to obtain in-network level of benefits with an out-of-network provider when: (i) you cannot schedule a visit within two-weeks, (ii) you are unable to locate a participating provider within a 10-mile radius in an urban-suburban area, or (iii) you are unable to locate a participating provider within a 20-mile radius in a rural area. You must submit a claim form to EyeMed for reimbursement. Complete the OON claim form, which includes additional information and requirements.

Caution, this option is not available when you choose to use an out-of-network provider due to (i) your preference or (ii) when your personal schedule does not permit you to schedule an appointment with an available provider in two-weeks.  Any person who, with intent to defraud or knowing that he or she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. 


Provider Nomination

Don't see your preferred doctor? Ask him or her to complete our online form at All doctors must accept our terms and conditions and complete credentialing before providing service to EyeMed members.


Need Assistance?

Visit the Help & Resources pages. Call us at (866)723.0512
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