GEHA will perform system maintenance on Sunday (January 20) from 4-6 p.m. Eastern 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 24 months from the original date of service at the out-of-network provider’s office.