How to File a Vision Claim

Purchases and vision exams made at a retail store:

Most vision care (exams, eyeglasses, frames, lenses, and contacts) are purchased at retail locations, such as Pearl, EyeMed, Lenscrafters, Costco, Walmart and independent retailers. Most of these locations require you to pay at the cash register, requiring you to file the claim form yourself.

Claim filing:

Click here to access a Vision Claim Submittal Form. Complete the form using your computer, print the form, attach the vision care receipt, showing the items purchased (a credit card receipt or cash receipt may not provide the detail), and submit both to Simple. Handwritten forms that are illegible, incomplete forms, or incorrect forms may not be processed.

Simple will send payment to you.

Your vision care provider files the claim for you.

Many ophthalmologists and optometrists will file the claim on your behalf. Many may ask that you pay your share of the cost at the time of the visit. Show your Vision plan ID card to your vision care provider. If you don’t have a vision card, you can print a verification of benefits here. Or, have your vision care provider call Simple at 800-270-4158 to verify coverage and plan details.

All claims should be submitted to Simple:

By Mail:
Simple
Claim Processing Office
2810 Premiere Parkway
Suite 400
Duluth, GA 30097

By Email:
simplecs@covenantservicesgroup.com

By Fax:
888-308-6009

You can print this page to take to your vision specialist by clicking here.