GEHA will be closed in observance of Martin Luther King Jr. Day on Monday, January 16. We will reopen at 7 a.m. Central time on Tuesday, January 17.

Connection Vision Out of Network Claim Form

You only need to complete this form if you are visiting a provider that is not a participating provider in the EyeMed network. Please complete and send this form to EyeMed within one (1) year from the original date of service at the out-of-network provider’s office.