Fee schedule vision claim

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Steps for completing a vision claim by using the paper form
You can file a vision claim if you purchased a vision rider with your Colonial Life dental insurance plan and would like to receive benefits to help cover an eye exam and/or vision correction materials.

Use these steps to guide you through the process of filing a vision claim. Keep in mind that filing claims online and setting up direct deposit are the fastest way to start receiving benefits. You also may print and complete the forms by hand.

  1. Download the vision claim form.
  2. For the fastest filing, fill out each section of the form on your computer. When you open the file, you'll see gray boxes, which indicate areas where you can type your information.
  3. Review and complete the Optional Service Release Agreement. This section allows you to provide permission for Colonial Life to release information about your claim to individuals you designate, send claim payments by overnight delivery and make direct deposits into your bank account.
  4. Complete the Vision exam/vision correction material section in its entirety. You also will need to include a copy of your bill for the vision eye exam, as well as a copy of the receipt for vision correction materials (prescription glasses, frames or contact lenses).
  5. Complete and sign the Certification section.
  6. Sign and date your claim form, and complete and sign the authorization page.
  7. Carefully review your forms to ensure all required sections are completed, including all areas where a signature and date are needed.
  8. Submit your claim online by logging in to your account. If you don't have an account, register here. This is the fastest way to start receiving benefits. You can file your claim, upload documentation for an existing claim, track the status of your claim and view other communication through your online account.
  9. Alternatively, you can fax your claim to 1-800-880-9325 or mail it to P.O. Box 100195, Columbia, SC 29202-3195.