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P.O. Box 91059 Seattle, WA 98111-9159 www.premera.com VISION MEMBER ENROLLMENT AND CHANGE APPLICATION 1. GROUP INFORMATION (to be completed by the group) Group ID Group name 1003968 Employee date

How to fill out vision member enrollment and

How to fill out vision member enrollment:

1. Begin by obtaining the vision member enrollment form, either from your employer or directly from your vision insurance provider.
2. Read through the instructions and gather any necessary documents or information you may need to provide, such as your personal identification details, contact information, and employer information.
3. Provide your personal details accurately, including your full name, date of birth, and social security number. This information is essential for verifying your eligibility and ensuring proper enrollment.
4. Fill out the contact information section, including your current address, phone number, and email address. This will ensure that any important communication or updates regarding your vision insurance can be easily delivered to you.
5. If applicable, provide your employer information, including the name, address, and contact details of your company. This information may be required for group enrollment or to determine any employer-specific benefits or contributions.
6. Carefully review the form to ensure that all information provided is accurate and complete. Any errors or omissions could potentially impact the enrollment process or coverage eligibility.
7. Once you are satisfied with the accuracy of the form, sign and date it. This acts as your agreement to the terms and conditions of the vision insurance plan.
8. Make a copy of the completed enrollment form for your own records before submitting it to your employer or vision insurance provider. This will allow you to reference the information provided and keep track of your enrollment process.

Who needs vision member enrollment:

1. Employees who wish to access vision insurance benefits offered by their employer.
2. Individuals who want to enroll in a standalone vision insurance plan for themselves or their dependents.
3. Those who require regular eye care services, such as routine check-ups, eyeglasses, contact lenses, or specialized treatments, and want to ensure coverage for these expenses.
4. Families or individuals who have specific vision needs and want financial protection against high out-of-pocket costs related to eye care.
5. Students, particularly those studying or working in fields that heavily rely on visual acuity, may find vision insurance beneficial in maintaining optimal eye health and addressing any vision problems that may arise.

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What is vision member enrollment?

Vision member enrollment refers to the process of registering individuals for vision coverage within a health insurance plan.

Who is required to file vision member enrollment?

Employers or organizations offering health insurance plans with vision coverage are required to file vision member enrollment.

How to fill out vision member enrollment?

Vision member enrollment can typically be filled out online through the employer's benefits portal or by filling out a paper form provided by the insurance company.

What is the purpose of vision member enrollment?

The purpose of vision member enrollment is to ensure that individuals are properly enrolled in the vision coverage offered by their health insurance plan.

What information must be reported on vision member enrollment?

Information such as the individual's name, date of birth, and any dependents needing coverage must be reported on vision member enrollment.