Group Vision Insurance

A Group Vision plan is especially attractive for employers because it is inexpensive to offer, yet it's another employee favorite. This is a separate plan that provides coverage for eye exams and/or for frames, lenses and contact lenses.

Many times the basic health plan may provide for routine eye examinations. However, it will usually not provide any benefit for frames, lenses or contact lenses; this is where a separate group vision benefit would be used.

 

Group Vision Insurance Quote Request

Please take a moment to fill out the form below and one of our local insurance agents will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.

* Required fields.

General Information
Legal Name of Business:
Contact Name: *
Address:
City:
State:	Zip:
Business Phone: *
Best Time To Call:	AM   PM
E-mail Address: *

Type of Business
Type of Business:
No. of Full Time Employees:	No. of Part Time Employees:
Give a complete description of any type of hazardous/dangerous duties performed by your employees:

Current Group Vision Insurance Information
Carrier (Company) Name (not agency):
Policy Expiration Date:	Premium Amt: $
Years Insured:
Please give a brief description of your current Group Vision plan:

Employee Information
Please list all employees you wish to cover:
Employee Name	Date of Birth	Zip Code	Sex	Dependent Status
			Male Fem	Emp. Only Emp. + Spouse Emp. + Child Emp. + Family
			Male Fem	Emp. Only Emp. + Spouse Emp. + Child Emp. + Family
			Male Fem	Emp. Only Emp. + Spouse Emp. + Child Emp. + Family
			Male Fem	Emp. Only Emp. + Spouse Emp. + Child Emp. + Family
			Male Fem	Emp. Only Emp. + Spouse Emp. + Child Emp. + Family
			Male Fem	Emp. Only Emp. + Spouse Emp. + Child Emp. + Family
			Male Fem	Emp. Only Emp. + Spouse Emp. + Child Emp. + Family
			Male Fem	Emp. Only Emp. + Spouse Emp. + Child Emp. + Family
			Male Fem	Emp. Only Emp. + Spouse Emp. + Child Emp. + Family
			Male Fem	Emp. Only Emp. + Spouse Emp. + Child Emp. + Family
			Male Fem	Emp. Only Emp. + Spouse Emp. + Child Emp. + Family
			Male Fem	Emp. Only Emp. + Spouse Emp. + Child Emp. + Family
			Male Fem	Emp. Only Emp. + Spouse Emp. + Child Emp. + Family
			Male Fem	Emp. Only Emp. + Spouse Emp. + Child Emp. + Family
			Male Fem	Emp. Only Emp. + Spouse Emp. + Child Emp. + Family
If you were not able to list all employees you wish to cover in the spaces above, please use the Additional Comments section below or indicate that you will fax or e-mail an additional listing.

Additional Comments or Questions

Enter Security Code:

Please click the "Submit Quote Request" button to send your quote request. No coverage is in effect until bound by an insurance carrier. This is a request for quotation only.