{"content":[{"text":"OUT-OF-NETWORK VISION SERVICES CLAIM FORM","bbox":{"left":0.073644,"top":0.053182,"width":0.482887,"height":0.01623700000000001}},{"text":"Claim submissions \n made easy \n WENT OUT-OF-NETWORK? NO PROBLEM, \n LET’S WALK THROUGH IT \n If you saw an out-of-network eye doctor and you have \n out-of-network benefits, your next step is to send us your \n completed claim form. You can now submit your form \n online or by mail:","bbox":{"left":0.073529,"top":0.095551,"width":0.45231399999999994,"height":0.22787100000000005}},{"text":"Online \n Click below to complete an \n electronic claim form. Go \n green and get paid faster.","bbox":{"left":0.074118,"top":0.345636,"width":0.20987299999999998,"height":0.07892200000000005}},{"text":"–OR–","bbox":{"left":0.309412,"top":0.341909,"width":0.07036900000000001,"height":0.025980000000000003}},{"text":"By mail \n Complete and return the \n following paperwork.","bbox":{"left":0.417255,"top":0.345636,"width":0.19573499999999994,"height":0.06124500000000005}},{"text":"Access Form","bbox":{"left":0.087933,"top":0.462685,"width":0.139882,"height":0.022733000000000003}},{"text":"If you will be using electronic assistive devices to complete the form, \n please use the online form.","bbox":{"left":0.073529,"top":0.509066,"width":0.5373890000000001,"height":0.03388800000000003}},{"text":"Claim forms must be submitted within 15 months of the date of \n service. For complete terms and conditions, review the claim form.","bbox":{"left":0.073529,"top":0.552273,"width":0.52281,"height":0.03324400000000005}},{"text":"Stay in-network and save on your next visit*","bbox":{"left":0.073529,"top":0.616773,"width":0.41527499999999995,"height":0.019484999999999975}},{"text":"CHOOSE AN EYE DOC","bbox":{"left":0.161765,"top":0.65399,"width":0.195729,"height":0.016236999999999946}},{"text":"With thousands of providers across the nation, you can \n see who you want to see, when and where you want \n to see them. Whether it’s an independent eye doctor, \n popular retailer or even online, you have options.","bbox":{"left":0.161765,"top":0.679495,"width":0.43602,"height":0.06859800000000005}},{"text":"Easily find an eye doctor on eyemed.com or on the \n EyeMed Members App. Search by location, store hours \n and more—and then schedule your appointment.**","bbox":{"left":0.161765,"top":0.757475,"width":0.4327530000000001,"height":0.050920999999999994}},{"text":"WATCH IT ADD UP","bbox":{"left":0.161765,"top":0.826995,"width":0.16308500000000004,"height":0.016236999999999946}},{"text":"Members who combine an eye exam and new glasses \n save an average of 72% off retail prices.††","bbox":{"left":0.161765,"top":0.8525,"width":0.4227290000000001,"height":0.03324499999999997}}],"images_bbox":[{"left":0.654998,"top":-0.001389,"width":0.346639,"height":1.002777}],"images_bbox_not_text_overlap":[{"left":0.654998,"top":-0.001389,"width":0.346639,"height":1.002777}]}