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Get Anthem Vision Reimbursement Form

Areas of the form by typing or printing clearly with a non-erasable ink pen. This form will be returned if either: 1. The form is not completed with the required information, or; 2. An original receipt is not attached to the back of this form. Anthem Blue Cross and Blue Shield (Anthem) will send reimbursement to the subscriber when approved. Please expect 6-8 weeks to process once Anthem receives this request for reimbursement. Member information 1 2 5 Last name First name Member identif.

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