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 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.
Out of Network Form (PDF) - Eligible employees wishing to submit an out of network claim must complete and submit this form.
Out of Network Instructions (PDF) - Eligible employees wishing to submit an out of network claim must follow these steps.
EyeMed Online Options (PDF) - Eligible employees may use the following online resources when pursuing in-network options.