Vision Enrollment

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AFSCME Retiree Vision Insurance Enrollment Form

"Your vision insurance through Davis Vision is only available to Chapter 13 Retiree members. You can pay online via bank draft or credit card, same way you did your dental insurance, or you can mail in a check for $24/year.

Your Davis Vision Insurance is active January 1, 2025 through December 31, 2025 and is paid yearly. Please note that the open enrollment period for Davis Vision is October 1st through December 1st. This plan goes into effect on January 1, 2025. If you have any questions about your Davis Vision Insurance, please call their Customer Service line at 1-800-923-2847 and give the representative the Group Number 5206 or visit www.davisvision.com.

Retiree Member #1:
Retiree Member #2:
Family Members:
Please list full names, birthdates and genders for all additional members to be enrolled.

(This information is available at www.davisvision.com)

I certify that this enrollment information is true and correct.
† By providing your cell phone number you consent to receive calls (including recorded or autodialed calls, or texts) at that number from AFSCME and its affiliated labor, political and charitable organizations on any subject matter. Your carrier’s rates may apply. You may modify your preferences at: afscme.org/tcpa