GET COVERED NOW GRIEVANCE FORM INDIVIDUALS GROUPS BROKERS PROVIDERS SEARCH CONTACT US FORMS You are here: Home \ Forms Online Forms For Members Grievance Form Use this form if you wish to report a complaint with Vision Plan of America regarding your membership Grievance Form (Spanish)/Proceso de Queja Use esta forma si necesita hacer una queja con Vision Plan of America sobre su plan de vision Status Change Form Use this form if you wish to make changes to your membership (such as change of name/address, change of provider, add/delete dependents, etc.) Status Change Form (Spanish)/Cambio de Estado Use esta forma si necesita hacer cambios a su membresía. (Por Ejemplo: Cambio de Nombre/Domicilio, Cambio de Proveedor, Agregar/Cancelar Dependientes, etc.) For Group Administrators Status Change Form Use this form if you wish to make changes to your membership (such as change of name/address, change of provider, add/delete dependents, etc.) Downloadable Forms and Documents Individual Plans A Pair and a Spare Plan Brochure Spanish A Pair and a Spare Plan Brochure Best Choice Plan Brochure VIP Premier Plan Brochure Emerald Plan Brochure 20/20 Plan Brochure 4 Plan Brochure Spanish 4 Plan Brochure Schedule of Extras Full Service Plans Co-Pay Plans Dental Benefits – Best Choice Plan Dental Benefits – Emerald Plan Provider Directories Vision Providers Directory Dental Providers Directory For Members Grievance Form Use this form if you wish to report a complaint with Vision Plan of America regarding your membership Grievance Form (Spanish)/Proceso de Queja Use esta forma si necesita hacer una queja con Vision Plan of America sobre su plan de vision Status Change Form Use this form if you wish to make changes to your membership (such as change of name/address, change of provider, add/delete dependents, etc.) Status Change Form (Spanish)/Cambio de Estado Use esta forma si necesita hacer cambios a su membresía. (Por Ejemplo: Cambio de Nombre/Domicilio, Cambio de Proveedor, Agregar/Cancelar Dependientes, etc.) MNCL Public Disclosure MNCL Public Disclosure (Spanish) For Group Administrators Vision and Dental Employee Enrollment Form Vision Employee Enrollment Form Status Change Form Use this form if you wish to make changes to your membership (such as change of name/address, change of provider, add/delete dependents, etc.) GET COVERED NOW GRIEVANCE FORM INDIVIDUALS GROUPS BROKERS PROVIDERS SEARCH CONTACT US Providers Click Here © 2018 Vision Plan of America