| Document Date: 2013-06-24 14:22:14
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City Mason / New York / Washington / / Company Plan Name Northeast Delta Dental Vision Plan Group / EyeMed Vision Care LLC / Red Tree Insurance Company Inc. / / Country Puerto Rico / / Currency USD / / Facility prison Tennessee / / IndustryTerm insurance claimant / state law / insurance / insurance application / insurance benefits / insurance proceeds / submitted vision care services / fraudulent insurance act / insurance fraud / insurance policy containing / organization employer / / Organization Colorado Division of Insurance / / / Position optometrist / / ProvinceOrState Texas / Kansas / New Jersey / Nebraska / Kentucky / West Virginia / Vermont / Ohio / Minnesota / Alaska / Maine / Maryland / Indiana / Oregon / Louisiana / Hawaii / Tennessee / New Mexico / District of Columbia / Pennsylvania / Rhode Island / Oklahoma / Delaware / Florida / North Carolina / California / Arizona / Colorado / Idaho / Arkansas / New Hampshire / / Region West Virginia / /
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OUT Of NETWORK VISION SERVICES CLAIM FORM Underwritten by Red Tree Insurance Company, Inc., an affiliate of the Northeast Delta Dental companies Claim Form Instructions Most EyeMed Vision Care plans allow members the cho