These
forms must be viewed with Acrobat Reader. Click here to
download the reader.
Employee
Enrollment Form
COBRA
Document
Employer Enrollment
Form (12/12)*
Agent
Data Sheet
Employer
Enrollment Form (12/24)*
Enrollment
Change Form
Out
Of Network Claims Form
Request
Login for OptiCare's Online Eye Health Manager - For
Employers only
* Refers to the time of contract validity. 12/12
is a contract renewable every year and
12/24 is a contract renewable every two years. Please select the
one that your contract is signed for.
