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Insurance Form

Do you currently have Vision Insurance?

We’re happy to help you with this process using the form below.

Many insurance companies offer reimbursement for out-of-network purchases. Once you’ve completed the form, we’re able to tell you how much you are eligible to receive as reimbursement. After you’ve completed your prescription or reader purchase on AmericanSunAndReader.com, we submit your claim and you are good to go! We're eyecare pros. :)

Fill out the form below to receive an insurance quote.

"*" indicates required fields

First Name*

Last Name*

Email*

Phone*

Full Address*

Birthday*

Sex*

Choose Your Vision Plan (Unfortunately if your plan is not listed we are unable to submit for reimbursement on your behalf)*

Primary Insured's First Name*

Relationship to Primary Insured*

Last FOUR Digits of the Primary's Social Security Number*

Employer or Group Number*

Phone

This field is for validation purposes and should be left unchanged.

Insurance Form

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