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EXTENDED HEALTH CARE and VISION CARE CLAIM FAXED CLAIMS NOT ACCEPTED Please answer all questions to support timely processing of your claim (see back for specific instructions). PLAN MEMBERS INFORMATION
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How to fill out and vision care claim

How to fill out a vision care claim:
01
Start by gathering all the necessary information, including your personal details, insurance policy number, and any supporting documents such as receipts or invoices.
02
Carefully review your insurance policy to understand what is covered and any specific requirements for submitting a vision care claim.
03
Begin filling out the claim form, ensuring that all sections are completed accurately and legibly.
04
Provide detailed information about the vision care services or products you are claiming, including the date of service, description, and cost.
05
Attach any supporting documents required, such as itemized receipts or invoices from your eye care provider.
06
Review the completed claim form and attachments for any errors or missing information before submitting it.
07
Submit the claim form and supporting documents to your insurance provider through the designated channel, such as online submission, mail, or fax.
08
Keep a copy of the completed claim form and all supporting documents for your records.
Who needs a vision care claim?
01
Individuals who have vision insurance coverage and have incurred expenses related to eye care services or products are eligible to file a vision care claim.
02
People who have undergone eye exams, purchased prescription eyeglasses or contact lenses, or received other qualified vision care services can benefit from submitting a vision care claim.
03
Vision care claims may also apply to dependents covered under a policy, such as children or spouses, who have utilized vision care services or purchased vision-related products.
Remember, it is important to refer to your specific insurance policy and consult with your insurance provider for precise instructions and requirements on filling out a vision care claim.
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