GEHA will be closed in observance of the Birthday of Martin Luther King Jr. on Monday, January 20. We will reopen at 7 a.m. Central time on Tuesday, January 21.

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 submit this form to EyeMed within 24 months from the original date of service at the out-of-network provider’s office.