Enrollment/Change Form Please print and complete all sections. See instructions below. Location Code Division Code N/A EMPLOYER INFORMATION Employer Name Group Number Effective Date 9681560 Georgetown.
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How to fill out the Eyemed Enrollment Form online
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.
- Click the ‘Get Form’ button to access the enrollment form and open it for completion.
- 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.
- 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.
- 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.
- Once all required sections are filled out, review the form for accuracy. Make necessary corrections before proceeding.
- 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.
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How do I create an EyeMed online account?
New users will need to create an account using your member ID or the last four digits of your social security number*. You'll then receive a registration email in your inbox to confirm your account. After registration, you'll be able to set up your new account. Enter your email and desired password.
Does EyeMed have an app?
That's why we created the EyeMed Members App – the industry's first mobile vision benefits app for members (available for iPhone and Android).
Can you use EyeMed at ?
You just need to see a vision provider who is part of the EyeMed network. Call EyeMed at 1-844-226-2850 (TTY: 711). Their network includes independent eye doctors and larger chains, such as Target Optical, Lenscrafters, Pearle Vision and select Optical locations.
Is EyeMed and vsp the same?
VSP and EyeMed are competitors. As such, they have different provider networks. Both VSP and EyeMed have a variety of vision insurance plans to choose from, with good ranges in price and coverage. To choose between the two, look at the different plans and provider networks.
What is the phone number for EyeMed?
For EyeMed Individual members only, that is if you have not enrolled through an employer, contact 844.225.3107 if you need a replacement card for your EyeMed Individual policy. If you are an EyeMed member through your employer contact 866.939.3633.
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