GEHA will perform system maintenance today (February 23), starting at 7 p.m. Central time and ending at about 9 p.m. Central time. Portions of this website might not be available during this time. We apologize for any inconvenience.

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.