Vision Care Plan

Filing Your Claim 

You don’t have to file a claim form when you use an EyeMed Vision Care network provider. Your network provider will file your claim for you. 

If you use an out-of-network provider for a covered service, you must: 

  • pay the out-of-network provider for the full cost of the service at the time the service is provided; and
  • submit your claim to the Claim Administrator for reimbursement (up to the maximum allowable amount). 

Itemized Receipt
EyeMed Vision Care will only accept itemized paid receipts that indicate: 

  • the service(s) provided; and
  • the amount charged for each service. 

The services must be paid in full in order to receive benefits. Handwritten receipts must be on the provider’s letterhead. Attach itemized paid receipts from your provider to the claim form. 

If the paid receipt is not in US dollars, please identify the currency in which the receipt was paid. 

It is important for you to obtain an itemized receipt for each covered out-of-network provider service. This receipt must accompany your claim for benefits.

Claim Form
Your claim for out-of-network services must be accompanied by: 

  • a properly completed claim form; and
  • an itemized receipt for the service.

You can obtain a claim form by calling EyeMed Vision Care Member/Patient Services at 1-877-829-5067 (or visit their website at for a downloadable copy). 

You can also obtain a claim form by contacting the Human Resources at 52222 or sending an e-mail to Benefits-HR/TRP.

Where to Send Your Claim: You should send your completed claim form along with proof of purchase (an itemized receipt) to the Claim Administrator at the address shown on the form. 

Claim Filing Deadline
You should file your claim for an out-of-network service within one year of the date that the applicable charge or expense for that service was incurred (or as soon as reasonably possible after that date). 

In no event (except in the case of legal incapacity) will a claim for an out-of-network service be accepted later than one year after the date that proof of loss is required. 

You can appeal a denied claim. The claim appeal procedures are described in the Administrative Information section of this Summary Plan Description (SPD). 

If payment for claims exceeds the amount for which a covered person is eligible under any benefit provision or rider of the group insurance policy, the Insurance Company has the right to recover the excess of such payment from the provider or the covered person. 

No covered person can bring an action at law or in equity to recover on the group insurance policy until more than 60 days after the date written proof of loss has been furnished according to the policy. No such action may be brought after the expiration of three years after the time written proof of loss is required to be furnished. If the time limit of the policy is less than allowed by the laws of the state where the covered person resides, the limit is extended to meet the minimum time allowed by such law.