Request a Quote
Name or person requesting the quote (broker/HR professional)
Agency Name (if applicable)
Name of Group/Company Name requesting Vision Plan Quote
How many eligible employees?
Group Effective Date
Select desired frame allowance
Include eye exam
No exam (hardware only)
Provide quote for both options
Voluntary Employee Paid
Contributory Employer Paid
Provide Quote with Both Options
If contributory, what percent of the premium is the employer paying?
Does this employer currently offer a vision plan?
If possible, please upload this group’s current vision plan and rates.
Demographic/Geographic Details: What other states (non-Utah) do the employees reside? What percent are in each geography? If 100% in Utah you can leave this section blank.
What level of involvement would you like from us?
Return quote in 24 hours
Schedule a meeting with agent/broker
Zoom/In-person presentation to employer
Full RFP to Come
Zoom/phone call with Opticare rep
Are you appointed with Opticare Vision Services (Opticare of Utah)?
Enter any additional details
Should be Empty: