Get Davis Vision Enrollment Application

Completing the Davis Vision Enrollment Application online is a crucial step in securing your vision care coverage. This guide will walk you through each section of the application to ensure a smooth and efficient process.

Follow the steps to successfully complete your enrollment application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the employee (member) information section. This includes your first name, middle initial, and last name. Ensure that all details are precisely printed.
3. Indicate the reason for your application by selecting from the options: Addition, Reinstate, Change, or COBRA.
4. Enter your employer or group name accurately to avoid any confusion with your coverage.
5. Check the type of coverage you are applying for—whether it is Employee Only, Employee and Spouse or Domestic Partner, Employee & Children, or Family.
6. Fill in your mailing address, including city, state, and zip code, to ensure you receive communications regarding your application.
7. Provide your employee identification number if it is available. This will help in identifying your record within the organization.
8. State your effective date by entering the month, day, and year in the respective fields.
9. Include your phone number for further correspondence related to your enrollment.
10. Select your employee status from the options such as Active, Hourly, Salary, or Retired and provide the retirement date if applicable.
11. If relevant, complete details for any dependents by entering their first name, middle initial, last name, birthdate, and other necessary information, including their relationship to you.
12. Sign the form to certify that all provided information is true and correct. This signature is required for all members and dependents listed.
13. After completing the form, save any changes, and consider downloading, printing, or sharing the document as needed.

Start filling out the Davis Vision Enrollment Application online today to ensure your vision coverage.