How to File a Delta Dental of Iowa Vision Insurance Claim Form

Posted on May 22, 2025 in Insurance

If you’re enrolled in a vision insurance plan, you might be bound to a network of providers in order to access insurance benefits. But, we know life happens. Sometimes it is hard to find an in-network eye doctor nearby, or the next available appointment at your preferred provider is too many days away to meet your needs. When that occurs, you might have to see an out-of-network provider.

The good news? You may still be eligible for reimbursement through your vision insurance by filing an out-of-network vision services claim form.

Not sure how? We've got you covered!

Finding the vision insurance claim form

To file your vision insurance claim, you’ll start by downloading the claim form right from our website.

Here’s how:

1. Go to our website at deltadentalia.com
2. Click on the "Agents" tab near the top left of the page
3. Hover over the "Agent Support" dropdown on the right and locate "Dental and Vision Forms"
4. Scroll down to "Vision Member Forms" and click "Claim Form"

Tips for filling out your vision insurance claim form 

1. Have your member information ready: Have your ID card nearby or pull up your account details by logging into your online account so you can easily enter your Patient Member ID, Vision Plan Name, and Vision Plan Group number.
2. Gather provider information: Locate your out-of-network provider’s name, address, and telephone number. You’ll need this information for the Claim Form.
3. Don't forget to attach receipts: Make sure your receipts clearly show the services provided, the dates, and the amounts paid.
4. Keep copies: Before submitting, take photos or scan your vision insurance claim form and receipts. That way you’ll have them available to reference in case you need to follow up.

Submitting your vision insurance claim form

Once your form is complete, submit it to EyeMed using one of the following methods:

By mail:

Place your completed vision insurance claim form and any required receipts in an envelope and send them to:

Attn: OON Claims

P.O. Box 8504

Mason, OH 45040-7111

Pro tip:  If you're filling out the vision insurance claim form by hand, be sure to use black or blue ink, and make sure all handwriting is clear and legible. This helps avoid processing delays and ensures your claim is reviewed without issue.

Online submission:

Visit EyeMed's Out-of-Network Claims page and follow the instructions to upload your vision insurance claim form and receipts electronically. 

Now that you know how to file a vision insurance claim, you can feel confident getting the care you need, even when it’s out of network. If you have questions or need help finding in-network providers, please don't hesitate to contact us for assistance!