To receive reimbursement for your vision and hearing benefit, see the following information:
Download Vision and Hearing Claims Form
NOTE: The Vision and Hearing Claim Form is for your convenience only and is not required to submit a claim. If you need to request a new form, you can call 800-264-4000.
Dental Claims should be submitted by your provider. If they are not submitted by your provider, please use the Vision and Hearing Claim Form.