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Eyemed reimbursement form

Eye med claim form 2025

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The document is an Out of Network Vision Services Claim Form administered by First American Administrators. It provides instructions for members of EyeMed Vision Care plans on how to submit claims for services received from non-participating providers. Key steps include ensuring all sections of the form are completed, attaching itemized paid receipts, and submitting the claim within 15 months of service. The document also includes a fraud warning section detailing legal consequences for submitting false claims.

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2018	4.8 Satisfied (102 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Will EyeMed reimburse Costco?

Use your EyeMed benefits to shop at your favorite in-network, online eyewear stores, like LensCrafters, Target Optical, Ray-Ban, Oakley, Glasses.com and ContactsDirect.

Does EyeMed do reimbursement?

You can visit an out-of-network provider and access your in-network level of benefits when you cannot schedule an appointment within two-weeks because there is no in-network provider available without excessive travel or delay. You must submit a claim form into EyeMed for reimbursement.

Does EyeMed reimburse for Costco?

When you visit one of our in-network eye doctors, you wont have to submit a claim, we take care of all the paperwork. If you saw an out-of-network doctor and you have out-of-network insurance benefits, your next step is to send us your completed claim form. You can now submit your form online or by mail.

Does EyeMed do reimbursements?

If you use a Costco, Wal-Mart or other non-network provider, you will need to pay the entire bill at the time services are provided and submit a completed claim form to EyeMed Vision Care. For services at all Costco and Wal-Mart optical locations, youll receive reimbursements equivalent to in-network benefits.