Get Ameritas Vision Claim Form - Sumterschoolsbenefits

Filing a vision claim can seem daunting, but understanding the process can help ensure that you receive the benefits owed to you. This guide offers clear, step-by-step instructions for completing the Ameritas Vision Claim Form - Sumterschoolsbenefits online.

Follow the steps to effectively complete your claim form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Part A, fill out the patient's name, including last, first, and middle names. This ensures accurate identification of the claim.
3. Provide the patient's birthdate. This information is necessary to verify the patient's age.
4. Indicate the patient's sex by selecting the appropriate box for male or female.
5. Complete the insured's name and social security number. This links the claim to the correct insurance policy.
6. Specify the relationship to the insured; choose from self, spouse, child, or other.
7. Fill in the insured's birthdate, street address, and city, state, and ZIP code. Providing a complete address is essential for correct processing.
8. Answer whether the patient is covered for eye care by another plan. If yes, provide the name and address of the other carrier.
9. If the patient is a dependent child age 19 or older, indicate if they are a full-time student and include their school’s name and address.
10. Sign and date the authorization section to confirm the accuracy of the information provided and your consent for benefits.
11. In Part B, the doctor must complete their section by providing their name, title, and examination date, along with details of any prescribed eyewear.
12. Part C requires the doctor or dispenser to document the charges for services provided, including the type of lenses and frame, as well as total charges.
13. Once all sections are completely filled out, ensure that all required signatures are provided.
14. Finally, save changes, and choose to download, print, or share the completed form before mailing it to the designated address.

Take the next step and complete your Ameritas Vision Claim Form online to ensure timely processing of your claim.