Get National Vision Administrators Enrollment Change Form

The National Vision Administrators Enrollment Change Form is essential for updating your vision coverage information. This guide provides clear, step-by-step instructions to help you efficiently complete the form online.

Follow the steps to complete the enrollment change form online.

1. Click ‘Get Form’ button to access the National Vision Administrators Enrollment Change Form and open it in your preferred online editor.
2. Fill out the employer (group) name and group number accurately. These details should match your organization's records.
3. Enter your full name, including your last name, first name, and middle initial. Use clear print or type for legibility.
4. Provide your street address, city, state, and ZIP code. Ensure that this information is current and correct to prevent communication delays.
5. Input your Social Security number. This number is essential for identification purposes.
6. Select your gender by marking the appropriate box.
7. Indicate the effective date of coverage or change. Remember, this must be the first of the month.
8. Enter your date of birth in the designated field.
9. Choose the contract type requested by checking the appropriate box: single, employee/spouse, family, or limited family.
10. Input your date of hire, providing clarity on your employment start date.
11. Complete the section for all family members requiring coverage. Include last name, first name, middle initial, gender, date of birth, and whether they are a student.
12. Select the appropriate action codes for any changes you are making. Indicate if this change is for you, your spouse, or dependent(s).
13. Mark the type of change you are requesting, such as new enrollment, address change, name change, reinstatement, issue card, cancel coverage, or former name if applicable.
14. Sign the form as the employee, and date your signature in the provided fields. This signature confirms your application for enrollment.
15. If required, have your employer sign the form in the designated space and note the date of their signature.
16. Once all fields are completed, save any changes, download or print the form for your records, or share it as needed.

Complete your National Vision Administrators Enrollment Change Form online today for a smooth experience.