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Vision insurance forms and claims for guardian life. Please log in to your guardian online (gol) account for: This article explains how guardian members can submit a vision claim, what information is needed, and where to send the completed form.
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To request reimbursement, complete this form (in blue or black ink), enclose a legible copy of your itemized receipt(s), and send them to the following address. Use this form to request reimbursement for services received from providers who do not participate in the davis vision network Expenses for both examinations and eyewear can be claimed on this form Only services listed on this form will be considered for reimbursement.
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