Get Healthcomp Group Vision Claim Form 2014-2025

This guide provides step-by-step instructions for completing the HealthComp Group Vision Claim Form electronically. By following these instructions, you can ensure that your claim is filled out correctly and submitted without hassle.

Follow the steps to complete your claim form online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred electronic editor.
2. Enter your policy and/or group number(s) at the top of the form, along with the name and address of your employer.
3. Provide the employee information by filling in the name and address of the employee (the insured). Include the employee's medical ID or Social Security Number and date of birth.
4. Indicate if there is other vision insurance coverage by selecting 'Yes' or 'No.' If 'Yes,' provide the name of the employer and the insurance company's address.
5. If the claim is for a dependent, complete the dependent's name, gender, date of birth, and indicate if they are a full-time student.
6. Complete the section for vision services by entering the date of service, services rendered, and the charges. Provide the physician or optometrist's name, address, and tax ID number.
7. Ensure the physician or optometrist signs and dates the form.
8. If applicable, fill out the section for vision supplies, including charges and details regarding lenses and frames, as well as the supplier's name and tax ID number.
9. Sign the authorization to release information section, confirming that the information provided is accurate. Include the date signed.
10. Complete the authorization to pay insurance benefits section, authorizing payment directly to the physician and acknowledging financial responsibility for any charges not covered.
11. Finally, attach any itemized bills to the form as required and follow the provided instructions for submission to HealthComp, Inc.

Complete your HealthComp Group Vision Claim Form online today for a seamless submission experience.