Request a Quote
Name or person requesting the quote (broker/HR professional)
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Agency Name (if applicable)
Name of Group/Company Name requesting Vision Plan Quote
How many eligible employees?
Group Effective Date
-
Month
-
Day
Year
Date
Select desired frame allowance
$100
$110
$130
$140
$160
$170
$210
Exam benefits
Include eye exam
No exam (hardware only)
Provide quote for both options
Premium Contribution
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?
Yes
No
If possible, please upload this group’s current vision plan and rates.
Browse Files
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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)?
Yes
No
Enter any additional details
Submit
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