Claim Forms

Most vision providers will submit claims on your behalf, but if you need to submit a claim yourself, please use the claim form linked below. Please check with your provider to verify if you need to submit a claim.

Submitting a claim

To submit a claim, download the form linked below, complete it, and return it to us along with a receipt from your provider. You can send it by any of the options below.

  • Email here
  • Fax to 855-400-9307, or
  • Mail to:
    Claims Department
    P.O. Box 14389
    Baton Rouge, LA 70898-9100
Download Form

Other vision forms:

Grievance Form - Request for review and reconsideration of a submitted claim.

AZ Health Coverage Appeal Information Packet - Important information for our members in Arizona about how to appeal decisions Starmount Life Insurance Company makes about your health coverage.

Special Discounts for Optical Members - Reference for special discounts on optical materials provided by Value Added (VA) and Service Plus (SP) providers in the First Look Vision Network.

Hearing Savings Plan Flyer - Learn how you can access savings on hearing instruments and accessories.

For additional forms and documents, visit your member website.