Avesis Vision Calculator
Please complete the form below to create a quote.
Agent/Agency Information
Name:
Email:
Phone Number:
Group Information
Employer Name:
State:
Please choose...
Alaska
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Zip Code:
Plan Design
Choose a Plan:
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Plus Plan A - $10/$10 Copay
Plus Plan B - $10/$25 Copay
Plus Plan C - $10/$0 Copay
Materials Only Plus - $10 Copay
Materials Only Plus - $25 Copay
Participation:
Please choose...
75%
Voluntary
Rate Tiers:
Please choose...
Employee Only, Employee + Family
Employee Only, Employee + One, Employee + Family
Employee Only, Employee + Spouse, Employee + Child(ren), Employee + Family
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