Get Eyemed Enrollment Form

Completing the Eyemed Enrollment Form online is a straightforward process that allows users to manage their vision coverage efficiently. This guide provides clear, step-by-step instructions designed to assist users in filling out each section of the form with confidence.

Follow the steps to successfully complete the Eyemed Enrollment Form.

1. Click the ‘Get Form’ button to access the enrollment form and open it for completion.
2. In the employer information section, enter the employer's legal name, group number, and optional location code if applicable. Make sure to also input the effective date for the coverage.
3. In the employee information section, indicate whether you are adding, terminating, or changing coverage by selecting the appropriate checkbox. Provide your gender, member ID, full name, date of birth, social security number, and home contact details.
4. For family information, list the eligible family members you wish to enroll. For each person, indicate whether you are adding, terminating, or changing their coverage by checking the corresponding boxes. Fill out their names, genders, dates of birth, and social security numbers.
5. Once all required sections are filled out, review the form for accuracy. Make necessary corrections before proceeding.
6. Finally, submit the completed form by saving the changes, and download, print, or share it as needed.

Complete your Eyemed Enrollment Form online now to ensure your vision coverage is properly managed.