Forms and Documents
Out-of-Network Claim Form
Most plans allow members the choice to visit an in-network or out-of-network vision care provider. Use this form to submit a vision claim from an out of network provider.
Provider Nomination Form
Don't see your preferred eye doctor? Download and complete the Provider Nomination Form (.pdf), forward it to your preferred eye doctor, have your preferred eye doctor complete the form and send it to our Network Development department. All doctors must accept our terms and conditions and complete our credentialing process before servicing members.
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