How do I submit a Vision Claim Form for Guardian Vision?

There is no specific claim form for ASO non-network vision, however, the below standard information must be submitted by either the member or provider. When the provider submits the claim information, the member will be notified via Explanation of Benefits (EOB) once Guardian has processed it.

The claim needs to include the following information along with the itemized bill:

• Name, address and phone number of the out-of-network provider
• Name, address and phone number of the employee
• Employee’s member ID
• Name of the plan
• Patient’s name, date of birth, address and phone number
• Patient’s relationship to the employee

Please submit the Vision claim to:

The Guardian Life Insurance Company of America
PO Box 8007
Appleton WI 54912-8007
Fax: 920-749-7119