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  • State Of Maryland Vision Claim Form

Get State Of Maryland Vision Claim Form

Do not write in this space STATE OF MARYLAND EMPLOYEES HEALTH / VISION PLAN EMPLOYEE CLAIM FORM Subscriber's Legal Name (Last, First, Middle Initial) Patient's Legal Name (Last, First, Middle Initial).

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Benefits include: A routine eye examination, including dilation as professionally indicated, every 12 months. A frame from “The Collection” (Fashion or Designer selection) and spectacle lenses, or one dispense of contact lenses, every 12 months.

For more information about how to enter the system, call Davis Vision member services at 1 (800) 999-5431. You can also send an email at our contact form. Please do not include personal / confidential information in your email message.

Children under age 19 get vision care if they are enrolled in Medicaid or a Maryland Health Connection health plan. Services include one eye exam and one pair of glasses per year, or contacts in lieu of glasses. Vision Plans - Maryland Health Connection marylandhealthconnection.gov https://.marylandhealthconnection.gov › vision-plans marylandhealthconnection.gov https://.marylandhealthconnection.gov › vision-plans

6. Mail or Email completed claim form to: Vision Care Processing Unit, P.O. Box 1525, Latham, NY 12110 or FedExClaims@davisvision.com.

Paid-in-full eye examinations, eyeglasses and contacts! One-year eyeglass breakage warranty included on plan eyewear at no additional cost! A comprehensive benefit ensuring low out-of-pocket cost to members and their families. Our goal is 100% member satisfaction.

Log in to your account and click on “Access Benefits and Forms” to download the Direct Reimbursement Claim Form. Follow the instructions on the form to submit your claim. You must include either your eye care professional's signature or a detailed receipt. Member FAQs - Davis Vision davisvision.com https://davisvision.com › members › faqs davisvision.com https://davisvision.com › members › faqs

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232