Submit the completed VSP Enrollment Form to your benefits administrator. You may also fax it to the provided number or send it via email if allowed by your organization. Ensure that all sections are filled accurately to avoid processing delays.

Important dates for submissions of this form include open enrollment periods, usually occurring in late autumn, and deadlines for new hires or qualifying events throughout the year. Specific dates can be confirmed with your HR department. Ensure you submit your application before the deadline to secure coverage.

The primary purpose of the VSP Vision Care Enrollment Form is to facilitate the enrollment of employees and their dependents in vision care coverage. This form collects vital information necessary for processing and activating health benefits. Timely and accurate submission ensures that all parties receive the appropriate coverage and support on time.

• 1. Employee Name: Includes last name, first name, and middle initial.
• 2. Social Security Number: Required for identification and processing benefits.
• 3. Home Address: The address where the employee resides.
• 4. Email Address: For communication regarding the enrollment.
• 5. Date of Birth: Employee's birth date in mm/dd/yyyy format.
• 6. Gender: Gender selection for coverage purposes.
• 7. Coverage Type: Select employee-only or family coverage.
• 8. Dependent Information: Sections to fill for each dependent's details.
• 9. Employee Signature: Acknowledges the accuracy of the information provided.

Failing to submit this form may result in a lack of vision coverage for the employee and their dependents. It can lead to missed opportunities for benefits and health care support. Timely submission is crucial to avoid any gaps in coverage.

• Coverage Delays: If the form is not submitted on time, coverage may be delayed.
• Dependent Exclusion: Dependents may not receive coverage if they are not listed properly.
• Processing Issues: Incomplete forms can cause significant delays in processing.
• Loss of Entitlement: Failure to submit may result in loss of benefits eligibility.
• Increased Out-of-pocket Costs: Late submissions can lead to out-of-pocket expenses for vision care.

• 1. New Employee Enrollment: To enroll for vision coverage when starting a new job.
• 2. Dependent Additions: To add new dependents to your existing coverage.
• 3. Life Events: To update your coverage after life changes.
• 4. Open Enrollment Period: To ensure coverage for the upcoming year.
• 5. Waiving Coverage: To formally opt-out of vision care when not needed.