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Get the free Vision Benefits of America Employee Enrollment and Change Form

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EMPLOYER NAME: ENROLLMENT/CHANGE / TERMINATION FORM ACCOUNT # / CLIENT ID # (VBA ONLY): (Revised 12/19/2011) EFFECTIVE DATE: st VBA Enrollments on the 1 day of the month VBA Terminations on the last
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Vision Benefits of America is a vision insurance plan provider that offers coverage for eye exams, glasses, and contact lenses.
Employees who are enrolled in a vision insurance plan through Vision Benefits of America are required to file claims for reimbursement.
To fill out Vision Benefits of America claims, employees must submit receipts and claim forms to the insurance provider for reimbursement.
The purpose of Vision Benefits of America is to help individuals afford routine eye care and corrective lenses through insurance coverage.
Employees must report their name, address, insurance policy number, date of service, and amount paid for eye care services on their Vision Benefits of America claims.
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