Form Name: Online Form: PDF: Administrative Preferred Click here Administrative Choice   Click here Administrative Direct   Click here Eyemed Plan info Click here Smile Rider   Click here Plan Administration Click here Request for Rate Form Click here Group Application Click here Click here Enrollment Form Click here Auto Pay Form Click here Smile Makers Click here Billing Questions Click here Employer Service Click here Enrollment Services Click here Member Service Click here

Corporate Office Address: 6683 Centerville Business Pkwy Centerville, Ohio 45459 Columbus Address: P.O Box 21747 Columbus, Ohio 43221 Phone: 614.451.2044 Cleveland Address: P.O Box 31850 Independence, Ohio 44131 Phone: 216.524.0087