Forms & Benefits

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Vision

Here are the two forms

1. Excess Vision Form (PDF)
2. Supplemental Optical (PDF)

In order to access your vision coverage, please follow these steps.
1. You may use any optical provider you choose. We do have discounts with both Davis Optical and Laufer (info is in the Benefit Booklet)
2. Once you have the receipt for services, complete the Excess Vision Form and send to the address on the form. The Excess vision benefit provides between $30 and $70 per year depending on your claim.
3. Once you have received an Explanation of Benefits from Fitzharris, send a copy of it along with the Supplemental Optical Form to DH Cook at the address on the form. Supplemental optical provides $125 towards optical coverage once every two years.