Davis Vision Insurance Form

Use this form to request reimbursement for services received from providers who do not participate in the davis vision network.

Davis vision insurance form. Expenses for both examinations and eyewear can be claimed on this form. For most people vision benefits plans are a bad deal. Direct reimbursement claim form important information. All that is needed is to provide your name.

Make sure that all sections are completed that you and the providers s have signed the form and that all services charges and service dates. Davis vision has been providing comprehensive vision care benefits for over 50 years. Direct reimbursement claim form important information. Use this form to request reimbursement for services received from providers who do not participate in the davis vision network.

A complete description of the benefits provisions conditions limitations and exclusions for the davis vision basic and expanded plans will be included in their respective certificate of insurance. Expenses for both examinations and eyewear can be claimed on this form. A dependent must be considered a full time student by the school attended. If any discrepancies exist between the information listed above and the legal plan documents the legal plan documents will govern.

Use this form to request reimbursement for services received from providers who do not participate in the davis vision network. Is defined as an unmarried child who is a full time student covered through age 24. For more information call davis vision customer service at 1 800 999 5431. Expenses for both examinations and eyewear can be claimed on this form.

Download the davis vision reimbursement claim form. Information shown on this website is not intended to be nor should be construed as professional advice. Only services listed on this form will be considered for reimbursement. Please return this form to davis vision via emai l fax or us postal mail at least 10 days before.

Student verification form. Most davis vision insurance plans also include an out of network benefit which could range from 0 to over 100. Those reviewing the information should consult with a qualified professional. In california davis vision may do business as davis vision insurance administrators.

The rest is on file it s that easy. Access to better vision begins with having the qualified eye care professionals in our network which helps us to ensure our members can find cost effective care and a variety of styles.