Vision Plan Enrollment Form
Open Enrollment Oct. 1 - Oct. 30
I hereby apply for the vision benefit offered to me through VSP, for which I am eligible. I understand that if I do not enroll within 30 days of my initial eligibility, then I will not be able to obtain the benefit until the next open enrollment period. Open enrollment is every October of each year. I understand that there is a two-year enrollment requirement, which means that I must keep this coverage for a full two years, if I am still employed with the agency.